Detailed guidelines on COB and its rules are available on the State's Health Association Web site. Visit the official site in the state of your residency for more information. Medicare and Medicaid plans have their own COB rules. If you are enrolled in such plans, request the information directly from the provider.
How to Understand the Coordination of Benefits Rule in Health Insurance. The term Coordination of Benefits (COB) refers to group health insurance policies. Group insurance is designed to provide coverage for all major medical bills but not exceeding 100% of the total expenses. What happens when two or more insurance companies have to split the costs of these expenses? COB was established to regulate this and to make it easy for policyholders. COB rules do not apply to individual policyholders.
Find out if you have more than one group insurance policy. For example, if you are employed, then your employer is likely to have your name included under the company's group policy. Similarly, if you have additional group coverage through membership in certain institutions, through your spouse's employer or through a group policy you purchased previously, then you need to learn more about COB rules.
Differentiate between primary and secondary companies. In case of health expenses, which insurance provider will pay first? The COB guidelines provide a detailed understanding on this aspect. Usually, your employer's plan would be the primary one to provide coverage to you while any other plan that shows you as dependent would be secondary. The primary provider pays first and the remaining amount needs to be adjusted by the secondary company in some cases.
Pay special attention to the kind of coverage in cases of dependent children when a couple is divorced or separated.
Check the COB with Medicare. If you have a Medicare policy, then COB rules have been specified by the CMS (Centers for Medicare & Medicaid Services). Request a copy to understand them in more detail.
Understand the claim settlement system between the primary and secondary insurance providers. Talk to your local agents to clarify your doubts.
Pick up a guide on COB and health insurance from your nearest bookstore. It will provide more detailed information.