Coordination of Benefits (Benefits Integration)

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Coordination of Benefits (Benefits Integration) Coordination of Benefits (COB) is a provision in most health plans that allows families with two wage earners covered by health benefit plans to receive up to 100% coverage for medical services. COB rules determine which plan is primary for you, your spouse and your dependent children. An insured, while disabled, may receive benefits from other sources, such as workers’ compensation, disability benefits received from other employer-sponsored plans, or auto insurance benefits. However, benefits payable under an individual plan may be reduced by other sources of income. Coordination of Benefits allows two people with coverage who are married or in a common-law relationship to be covered as dependants by each other's plans. Eligible expenses can be submitted under both members' certificate numbers, providing greater reimbursement (up to 100%) to the family. There are two main types of COB: Primary-secondary: This is the most common type of COB. In a primary-secondary situation, one plan is designated as the primary payer and the other plan is designated as the secondary payer. The primary payer will pay its portion of the claim first, and then the secondary payer will pay its portion of the claim, up to the amount of the covered expenses that have not already been paid. Coordination of multiple payers: This type of COB applies when you are covered by more than two health insurance plans. In this case, the insurance companies will work together to determine which plan is responsible for paying the majority of the claim, and then the other plans will pay their respective portions of the claim. The coordination of benefits (COB) provision in group health plans prevents duplicate benefit payments to insureds who have coverage under more than one group insurance plan. Coordination of benefits can be a complex process, but it is important to understand how it works so that you can get the most out of your health insurance coverage. If you have any questions about COB, you should contact your insurance agent or broker directly. #benewinsurance #insurtech #inclusiveinsurance #insurance #reinsurance #takaful

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