Health Insurance Topics – Understanding Coordination of Benefits

oordination of benefits (COB) is basically a guideline that is set forth to help execute the rules and regulations involved in group health insurance coverage. When you have more than one group health insurance plan, you need to know which is your primary plan, which is secondary, and what each covers so that you can file health insurance claims accordingly. This can all get very confusing if you are not prepared and informed about coordination of benefits, so education is the first step in understanding your medical insurance coverage.

Coordination of benefits states who gets to pay for your healthcare expenses first, and who pays second. For example, if you have a health plan through your employer and a health plan through a membership with another institution, the primary plan is usually the employer-sponsored one. The secondary plan is the one that lists you as a dependent, in most cases. The goal of coordination of benefits is to create an effective order for claims filing and healthcare coverage that covers up to 100% of your expenses and no more. This helps to avoid double coverage and eliminate complications with having more than one health insurance policy.

People who have social security benefits, such as Medicaid or Medicare, have a completely different set of COB rules to follow than what private insurance companies follow. Every state has different guidelines and requirements for this type of situation, so it is also important to understand what your state requires and what their guidelines are for group coverage when you have more than one policy in place. Another important thing to watch is the coverage of dependent children in the event of a divorce or separation. These are all different elements that you have to understand when you have more than one group health policy.

One of the best ways to learn about coordination of benefits and understand how it applies to you is to talk to a health insurance agent or professional who understands group health coverage. These professionals are readily available to you and free of charge for you to work with, no matter what you might be looking for. Take the time to learn from them, because their experience will help you understand everything that you need to know. COB guidelines are not applicable to individual health insurance policies, so if that is the only coverage that you have you do not need to worry about this topic.

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