Coordination of benefits who is primary

You can locate COB information in the health insurer's certificate of coverage or call your insurance company. The certificate is often online, so you can check your insurance company's site first to see if that is provided there. Having two health plans may mean having to pay two premiums. However, two health plans may also help reduce out-of-pocket expenses when you need health care. The health plan that pays first and which one pays second depends on the type of plans and the situation.

Check the table earlier on the page to see some of the scenarios. COB is a process that decides which health plan pays first when you have multiple health insurance plans. These plans are called primary and secondary plans. The health insurance plans handle the COB. The plan type guides a COB. Factors that play a part in deciding which plan pays first are based on the state and size and type of the type of plan.

Large employer plans can create their own rules. After you receive health care services, the provider bills the insurance company or companies. The primary insurance company reviews the claims first and decides what it owes. Then, the secondary plan reviews what's left of the bill and provides its payment.

Once the payers handle their parts of the medical claim, the patient receives a bill from the provider for the rest of the medical costs. Mobile nav. Zip Valid zip code required. Get Quotes. Key Takeaways Health insurance plans have a coordination of benefits system when the member has multiple health plans. The health plan that pays first depends on the type of plan, size of the company and location.

The order in which the insurance policies are coordinated is dictated by insurance law and cannot be decided by a company or an individual.

This process takes place only when multiple insurance plans are involved. If only one plan is held, then all responsibility is put onto the sole plan. Predominantly, coordination of benefits happens when an individual has two plans in place primary and secondary , but it may also include a tertiary plan in some circumstances. The primary insurance plan is given the responsibility of being the first payer, the secondary plan is the second payer, and so on depending on how many plans the individual holds.

The primary plan is always considered as the predominant provider of benefits, and it must provide these as though the claim holder does not have a second or third policy in place. The COB provisions that are specified in the insurance policy outline which plan is the primary plan. Once identified, the primary plan's benefits are applied to the claim first.

But in most cases your health insurance is primary. So your health plan will pay first, and if there are expenses left over not covered by your plan, your auto insurance will pay those. You hurt your elbow and need to go to a doctor. When we send you a form that asks if you have more than one health insurance plan, you should respond, even if the answer is no.

If we contact you about subrogation, you should also respond.