Content Overview
- Summary
- What is Coordination of Benefits?
- How Coordination of Benefits Works
- Two Examples Of How Coordination Of Benefits Works
- How To Determine Which Plan Is Primary In General
- How To Determine Which Plan Is Primary: Both Plans Are Group Health Coverage And Both Have Coordination Of Benefits Provisions Included In The Policy
- How To Determine Which Plan Is Primary: One Plan Is Medicare. The Other Plan Is A Group Health Plan.
- How To Determine Which Plan Is Primary: One Plan Is Medicaid; The Other Plan Is A Group Health Plan.
- How To Determine Which Plan Is Primary: One Plan Is An Individual Health Insurance Plan; The Other Plan Is Group Health Coverage.
- How To Determine Which Plan is Primary: There are three plans in effect.
- When One or Both Plans are HMOs
Coordination Of Benefits : When You Are Covered Under Two Or More Health Plans
How To Determine Which Plan Is Primary: One Plan Is An Individual Health Insurance Plan; The Other Plan Is Group Health Coverage.
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Because individual plans do not have the Coordination of Benefits provision attached, there is no coordination between the two plans.
If you're covered under a group plan and an individual health insurance plan, each plan will pay their full benefits without regard to what the other plan pays. This means someone covered under a group plan and an individual plan could actually make a profit.
For example, if the bill is $4,000, the group plan pays $3,000 and the individual plan pays $2,500, you would be entitled to keep the $1,500 left over after paying the bill.
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