Coordination of Benefits - Group Health Insurance
by Colleen Posey

Coordination of Benefits – Group Health Insurance

There may be circumstances where an individual is enrolled in two health insurance policies. For example, an individual is enrolled in a policy through his employer, and is also enrolled under his spouse’s policy at the same time.  When these two policies work together to pay claims, it’s called Coordination of Benefits. It is imperative if you are in a scenario similar to the one described, that you inform both insurance carriers of the dual coverage to establish which plan is primary vs secondary. This allows the two insurance carriers to work together and avoid duplicate payments on the same claim. Whichever policy is designated as primary will pay first, and whatever it does not pay will then be sent to the secondary insurance carrier for review. The insurance carrier may send you a form asking if you have more than one health insurance policy. It is important to complete this form and send back, even if the answer is no. This will prevent any future disruptions in your health coverage.

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