The method of determining which company pays as primary insurer and which company pays as secondary or excess insurer when a working couple or their dependents have a claim covered by more than 1 group insurance contract.

When you are covered by more than one type of insurance that covers the same health care expenses, one pays its benefits in full as the primary payer and others pays a reduced benefit as a secondary or third payer. When the primary payer doesn't cover a particular service but the secondary payer does, the secondary payer will pay up to its benefit limit as if it were the primary payer.

a method of integrating benefits payable for the same patient under more than one plan. Benefits from all sources should not exceed 100% of the total charges.

a provision that applies if you are covered under more than one healthcare plan. It requires that payment of benefits be coordinated by the plans to eliminate duplication of benefits.

A provision in a health insurance policy that eliminates duplicate payments when there is coverage under more than one health plan.

a procedure used by insurance companies to keep individuals from collecting more in benefits that was actually charged for services covered under more than one health insurance policy; no matter how many policies a person has, this provision limits the benefits that can be paid on each claim to 100 percent of the expenses covered; COB provisions also designate the order in which the multiple carriers are to pay benefits.

The determination of primary, secondary, and tertiary insurer responsibility for a patient's health claim and the passing of claim and payment information between insurers.

(COB) - The transmission from any entity to a health plan for the purpose of determining the relative payment responsibilities of the health plan for health care.

Provisions and procedures used by insurers to avoid duplicate payments for subscribers and families insured under more than one group policy. COB attempts to ensure that subscribers receive all benefits they are entitled to without profiting from illness or injury.

A provision in an insurance plan that when a patient is covered under more than one group plan, benefits paid by all plans will be limited to 100 percent of the actual charge.

An insurance provision whereby responsibility for primary payment for medical services is allocated among carriers when a person is covered by more than one employer-sponsored health benefit program. This prevents beneficiaries from being reimbursed for more than 100% of allowable charges.

The process of using other insurance plans (families health plan, automobile or a third party's) to pay for the child's medical needs in full or in combination with CMDP.

a method of integrating benefits payable under more than one group health insurance plan so that the insurer's benefits from all sources do not exceed 100 percent of his/her allowable medical expenses. If this form is not filled out and returned to the insurance carrier, the carrier will reject the services.

Employees may be covered by two or more plans (theirs and their spouse/partner) at the time that services are rendered. COB is a method of integrating benefits under more than one group health insurance plan so that the insured's benefits from all sources do not exceed 100% of the allowable medical expense.

Provisions and procedures used by insurers to avoid duplicate payments when a person is covered by more than one policy.

A method of coordinating reimbursements for health care treatment and supplies when you or a family member is enrolled in more than one health care plan — for example, medical and auto insurance or the Northrop Grumman plan and your spouseâ€(tm)s employerâ€(tm)s plan.

The provision that limits benefits for members with multiple benefits plans.

A process through which individuals/families with access to more than one insurance plan and/or drug benefit program sequentially submit their claims to their insurers. The portion of the drug cost not paid for by the first insurer is claimed through the second insurer. See the Coordination of Benefits button on the sidebar

A clause included in health plans or established by law to determine the order of responsibility for benefits in situations where a Participant has coverage under more than one plan. Most plans use a variation of the NAIC model coordination of benefits rule (also known as the birthday rule).

COB is a system which ensures that benefits aren't paid by other policies or plans.  The Coordination of Benefits may also ensure that coverage will be provided in a specific sequence when more than one policy or plan covers the claim.

when you are covered under two medical plans, coordination of benefits is how Blue Cross Blue Shield of Mississippi decides which plan covers your care first.

The ability to make a claim for Extended Health Care and/or Dental eligible expenses under your Benefits Plan and your spouse's benefits plan. This allows you to receive up to 100% reimbursement for an eligible Extended Health Care or Dental expense.

A typical insurance provision whereby responsibility for payment for medical services is allocated between carriers when a person is covered by more than one group health benefit program. Download a Coordination of Benefits form.

The method of determining primary responsibility for payment of covered services under the terms of the applicable benefit agreement, and applicable laws and regulations, when more than one payor may have liability for payment for services rendered to a member.

A policy which will determine how benefits will be calculated if the claimant is insured under several group contracts insuring the same event.

Provision in a group heath insurance policy which permits companies to decide who pays benefits if more than one group plan is in effect.

A policy provision permitting coordination of medical care benefits.

The health plan provision that determines the order in which benefits will be paid when an individual is covered under two medical insurance plans. This provision prevents double payment of benefits. Find this section in your contract.

A contractual provision to prevent an insured from receiving duplicate benefits from two or more group plans and profiting from over-insurance.

A provision in the Certificate of Coverage requiring that, when an insured is covered under more than one medical plan, payment of benefits be coordinated between the medical plans in order to avoid duplication of benefits.

If the patient is covered under more than one insurance policy, the "coordination of benefits" principle states that he or she cannot collect payment amounts that total more than what was charged by the health care provider.

A term used when a member has medical coverage from two different sources and both parties share the cost. The COB department handles all insurance matters.

A type of provision in a group health policy which allows members with more than one insurance policy to determine who the primary carrier is. This prevents claim overpayment.

means when a Covered Person has two or more insurance plans, including this Plan, then the plans will coordinate benefits when a claim is received.

Determining the who is responsible for what when two or more health plans have some financial responsibility for a medical claim.

If the patient is insured under more than one plan (for example, the patient and the patient's spouse have family coverage from two different employers), COB determines which plan is responsible for which services and in what sequence the coverage will apply. COB is designed to eliminate duplicate coverage in these situations.

The determination of which of two or more plans or other third party payors are primarily or secondarily responsible for covered services provided to an enrollee. Such coordination is intended to preclude the enrollee from receiving an aggregate of more than one hundred percent (100%) of covered charges from all coverage. When the primary and secondary benefits are coordinated, determination of liability will be in accordance with the usual procedures employed by the California Department of Insurance and applicable state and federal regulations.

cost-sharing that occurs when a patient is eligible for coverage by more than one insurance plan. The benefits of the plans are coordinated so that the patient may receive up to 100% coverage for medical costs.

The process for making sure that all of your insurance plans which cover your drug costs have paid their share of the cost.

An employee may be covered under a spouse's group insurance program and children may be covered as dependents under two policies. When this occurs the two companies coordinate the payment of benefits. One company becomes a primary carrier and the other the secondary carrier. Once benefits are paid under the primary insurer, the employee may file for benefits under the secondary insurer. (See primary and secondary insurer). The total benefits payable under the two plans will not be more than 100% of the allowable expense.

When a member is covered under more than one group health plan or is receiving additional health care coverage, for example, that is related to a car accident or workers’ compensation, benefit payments are coordinated so duplicate payments for related services do not occur.

Provision regulating payments to eliminate duplicate coverage when a subscriber is covered by multiple group or pharmacy benefit plans. The procedures set forth in a Subscription Agreement to determine which coverage is primary for payment of benefits to Members with duplicate coverage. Used by insurers to avoid duplicate payment for losses insured under more than one insurance policy. A coordination of benefits, or "nonduplication," clause in either policy prevents double payment by making one insurer the primary payer, and assuring that not more than 100 percent of the cost is covered.

A way to integrate benefits payable under more than one health insurance plan that the insured may have. As a result, the benefits from all sources do not exceed 100% of allowable medical expenses or eliminate appropriate patient incentives to contain costs.

A term used to describe the provision that limits benefits for enrollees with multiple group insurance to 100% of the covered expenses and designates the order in which the multiple plans will pay benefits.

Standard rules and procedures that help determine which of two or more payers is primary and which is supplementary; such procedures seek to avoid duplicate claims payments.

A claims handling procedure used by health care insurers to make certain that when a person who makes a claim has duplicate coverage, not more than 100 percent of the cost of the care rendered is paid.

the process governing the payment of claims when you have a source of coverage in addition to TRICARE. Your other health insurance policy will pay for your benefits first; TRICARE coverage will be secondary.

Provision in a contract that applies when a person is covered by more than one group dental program. It requires that all programs coordinate payment of benefits to eliminate overinsurance or duplication of benefits.

Method of integrating benefits payable under more than one health insurance plan so that the insured's benefits from all sources do not exceed plan benefit percentages and/or 100 percent of allowable medical expenses.

The provision which applies when an enrollee is covered by two health plans at the same time. The provision is designed so that the payments of both plans do not exceed 100% of the covered charges. The provision also designates the order in which the multiple health plans are to pay benefits. Under a COB provision, one plan is determined to be primary and its benefits are applied to the claim first. The unpaid balance is usually paid by the secondary plan to the limit of its responsibility. Benefits are thus "coordinated" between the two health plans.

The process of determining benefits used when a member has more than one health insurance carrier and Benesight is the secondary carrier.

Provision that applies when a person is covered by more than one insurance plan. Coordination of Benefits requires that payment of benefits be coordinated by all plans in order to eliminate over-insurance or duplication of benefits.

A group plan provision that stipulates the primary carrier when you have more than one health plan. This ensures that payments made by the carriers do no exceed the cost of the services provided.

A typical insurance provision whereby responsibility for payment for medical services is allocated between carriers when a person is covered by more than one health benefit program. This coordination avoids the possibility that a person will be reimbursed twice for the same services.

The sharing of costs by two or more health plans, based on their respective financial responsibilities for medical claims. Your primary insurance and secondary insurance must coordinate benefits in order to pay claims.

The mechanism used in group health insurance to designate the order in which the multiple carriers are to pay benefits and to prevent duplicate payments.

Provisions and procedures of insurers used to avoid duplicate payments when claims are covered by more than one insurance policy.

A program that determines which plan or insurance policy will pay first if two health plans or insurance policies cover the same benefits. If one of the plans is a Medicare health plan, Federal law may decide who pays first.

A process for determining the respective responsibilities of two or more health plans that have some financial responsibility for a medical claim.

a provision under a group health plan that clarifies the order in which plans will pay if a given person has coverage under more than one plan.

A provision in a health insurance policy that applies when a person is covered under more than one group medical program. It requires the payment of benefits to be coordinated by all insurers who cover that person in order to eliminate over-insurance or duplication of benefits.

a provision in the contract that applies when a person is covered under more than one medical plan. It requires that payment of benefits be coordinated by all plans to eliminate overinsurance or duplication of benefits.

Involves a coordination of benefit payments for healthcare services provided to members who have more than one healthcare contract.

Rules that determine which insurance is to be billed first (primary) for services when patient is covered by more than one carrier. State and Federal guidelines apply.

Method of integrating benefits payable under more than one health insurance plan so that the insured's benefits from all sources do not exceed 100 percent of allowable medical expenses or eliminate incentives to contain costs.

A provision designed to avoid duplicate payments or payments in excess of charges for benefits covered under more than one individual or group contract.

When someone is covered by more than one group health plan or has automobile insurance that pays health care expenses without regard to fault, this is called double coverage. When you have double coverage, one plan normally pays its benefits in full as the primary payer and the other plan pays a reduced benefit as secondary payer.

A method of eliminating duplication of benefits when you are covered under more than one group plan so that your benefits from the two plans do not exceed 100% of allowable medical expenses.

A program that coordinates the subscriber’s health benefits when the person is covered under more than one group health plan.

Methods of integration benefits payable under more than one health plan so that the insider's benefits from all sources do not exceed 100 percent of allowable medical expenses.

A group policy provision which helps determine the primary carrier in situations where an insured is covered by more than one policy. This provision prevents an insured from receiving claims overpayments.

Coordination of benefits prevents duplication or overlapping for the same expense when a policyholder owns two or more group policies. This allows one insurance carrier to be aware of any other insurance coverage the policyholder may have. The two companies determine which company has the primary responsibility to pay and which company has the secondary responsibility after the benefits from the primary insurer are exhausted.

How insurance organizations determine the primary payment source when you are covered under more than one insurance organization or group medical plan. Many insurance contracts state that if you are covered under more than one insurance plan, benefits will be coordinated so that total benefits paid will not be more than 100% of the bill.

A system to eliminate duplication of benefits when a person is covered under more than one group health insurance plan. Benefits under the two plans usually are limited to no more than 100% of the claim .

A group health insurance policy provision designed to eliminate duplicate payments and provide the sequence in which coverage will apply (primary and secondary) when a person is insured under two contracts.

A mechanism allowing a Member covered by more than one health plan to potentially recover up to 100% of the billed amount of a claim. Generally, the primary (first) plan pays the greater amount, and the secondary plan pays the balance.

A provision in an insurance plan wherein a person covered under more than one group plan, has benefits coordinated such that all payments are limited to 100% of the actual charge or allowance. Most plans also specify rules whereby one insurer is considered primary and the other is considered secondary.

The contract provision that prevents a claimant from profiting by collecting from two different group plans such that the total is greater than actual expenses. COB provisions provide for primary and secondary status for the various plans involved and seek to guarantee that the total paid by all will not exceed 100% of the out-of-pocket expenses of the claimant.

COB applies if you or a family member is covered under another medical plan in addition to the coverage you have through AACPS. The benefits payable under you AACPS-sponsored coverage are coordinated with the other plan so that your total benefits from both plans will not exceed 100 percent of the benefit.

When the covered person is covered by another plan or plans, the benefits under the policy and the other Plan(s) will be coordinated so benefits from all sources do not exceed 100 percent of allowable expenses. This means one Plan pays its full benefits, then the other Plan(s) pay(s).

An agreement using language developed by the National Association of Insurance Commissioners that prevents double payment for services when an insured has coverage from two or more sources. The agreement determines which organization has primary responsibility for payment and which has secondary responsibility.

Provisions and procedures used by third-party payers to determine the amount payable to each payer when a claimant is covered under two or more group health plans.

Method of integrating benefits payments from all health insurance sources to ensure that payments do not exceed 100 percent of the covered healthcare expenses. Back to the top of the page

A system to eliminate duplication of benefits when you are covered under more than one group plan. Benefits under the two plans are usually limited to no more than 100 percent of the claim.

A provision in a contract that applies when a person is covered under more than one group health benefits program. It requires that payment of benefits be coordinated by all programs to eliminate overinsurance or duplication of benefits.

A provision that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. It avoids claims payment delays by establishing an order in which plans pay their claims and providing the authority for the orderly transfer of information needed to pay claims promptly. It may avoid duplication of benefits by permitting a reduction of the benefits of a plan when, by the rules established by this provision, it does not have to pay its benefits first. Refer to the Coordination of Benefits section of your applicable plan document.

Used in group health insurance, this distinguishes the order that two or more insurance companies will pay benefits for the same claim.

When a patient is covered by more than one dental plan.

also COB. Applies when a member is covered by more than one group contract or commercial insurance policy providing benefits for like services. COB is a method of limiting insurance settlement to no more than 100 percent of one carrier’s settlement arrangement.

A provision in a health insurance plan that tells which health plan or insurance policy pays first if two health plans or insurance policies cover the same benefits. If one of the plans is Medicare, federal law may determine who pays first.

A provision in group health policies specifying that benefits will not be paid for amounts reimbursed by other group health insurers.