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Coordination Of Benefits : When You Are Covered Under Two Or More Health Plans


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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." 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.

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 has two individual policies, there are no standardized coordination of benefits rules.

For information, see:

To learn about filing a claim, see: How To File A Claim Where There Is More Than One Health Insurance Coverage, Medicare Coordination of Benefits.

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