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

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:

• 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
  • When Both Are Group Plans And Both Have Coordination Of Benefits Provisions Included In The Policy
  • One Plan is Medicare and One Plan Is A Group Plan
  • One Plan Is Medicaid And One Plan Is A Group Plan
  • One Plan Is Individual And One Plan Is A Group Plan
  • There Are Three Plans In Effect
  • One Or Both Plans Are HMOs

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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