When submitting a claim with COB, make sure to submit both the original receipt for the expense, as well as proof of what the dependent’s primary insurer approved (or denied).
Coordination of Benefits
COORDINATION OF BENEFITS (COB)
When a person has coverage under more than one plan, benefits are coordinated to determine which insurer should process a claim first. COB ensures that the total benefits from all plans do not exceed the actual expense.
FOR SPOUSES / PARTNERS
If your spouse / partner has coverage for an expense under their own benefits plan (either a group plan, private plan, or government plan), then their primary insurer will be required to process a claim before any remaining expenses can be submitted to our insurer.
FOR CHILDREN
If you have a child listed as a dependent, and they have coverage under another benefits plan (typically through another parent), then COB determines the primary insurer based on the birthday (month / day only) of the certificate holders. The certificate holder whose birthday occurs first in the year will be designated as the primary insurer for the child’s claims.
For example, if your birthday is Oct. 10, 1974, and your spouse’s birthday is February 3, 1979, the primary insurer would be your spouse, since in the calendar year, they birthday is first.
If you are separated or divorced, the plan which will pay benefits for your children will be determined in the following order:
1. the plan of the parent with custody of the child;
2. the plan of the spouse of the parent with custody of the child;
3. the plan of the parent without custody of the child;
4. the plan of the spouse of the parent without custody of the child
TIP!
Additional Notes:
If any claims are eligible for reimbursement from any government insurance plan, they should first be submitted to that plan. The balance of the claim may be submitted to this plan as described above.