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
Summary
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If you have health insurance through more than one plan, and at least one of the policies is a group policy, there are rules that coordinate the two policies. These rules are known as "coordination of benefits." The same rules apply to all types of health insurance.
- Step 1. Look at the Coordination of Benefit rules to understand what happens between the "primary" company (the one to pay first) and the "secondary" company ''" the one to pay second.
- Step 2. Determine which insurer is "primary" and which is "secondary".
- Step 3. Tweak the rules if one or both plans are of the managed care variety, such as HMOs.
If one of your coverages is through Medicare, special rules apply.
If you are one of the rare people who two individual policies, there are no standardized coordination of benefits rules.
To learn more, see: How To File A Claim Where There Is More Than One Health Insurance Coverage, Medicare Coordination of Benefits.
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