You are here: Home Insurance Health Insurance ... Glossary of ... Coordination Of Benefits
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Glossary of Health Insurance Terms To Know

Coordination Of Benefits

Next » « Previous


Coordination of Benefits provisions eliminate the potential for insureds to obtain reimbursement for medical expenses from more than one insurer when there is more than one health insurance coverage. Without coordination of benefit provisions, an insured could obtain reimbursement for more than 100% of the cost of a medical service.

Industry practice with respect to Coordination of Benefits also helps determine which insurer pays first, and in what amount.

The specifics of how more than one coverage is handled between insurance companies is not generally relevant to the insured because the insured submits the claim to both companies. It is then up to the companies to figure out which one pays how much. However, to give you an idea of how Coordination of Benefits works, the sequence starts as follows:

  • The plan which covers the individual as an employee pays first.
  • The plan covering the individual as a dependent covers second.
  • If both plans cover the individual as a dependent, the plan of the employee whose birthday occurs soonest in the year pays first. This rule ("the birthday rule") applies only if both plans have adopted the birthday rule. If either plan has not adopted the birthday rule, the plan of the male parent will pay first. 

Some employers use an alternative Coordination of Benefits system called Maintenance Of Benefit.

To learn more about how Coordination of Benefits works, click here. Note that Medicare has its own rules with respect to coordination of benefits. To learn about the Medicare rules, click here. To learn how to file a claim when there is more than one coverage, click here.

Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.