Coordination of Benefits in health insurance

Coordination of Benefits defines how the cost of reimbursing expenses would be split by the insurance providers if the policyholders have purchased are a part of more than one group insurance plan.

Imagine that your employer offers health insurance benefits through the company’s group health insurance policy. Also, you have health coverage through memberships in certain institutions. In addition, you are also covered for your medical bills by your spouse’s employer in another group policy. All the above insurance plans would offer reimbursement for the medical bills.

In the past, when people were part of more than one group insurance plan, they can file separate claims under each plan and enjoy coverage benefits. The Coordination of Benefits was then established to discourage filing multiple claims under the same event and ensures that the reimbursement that does not exceed the total expenses incurred. At the same time, it provides the advantage maximum coverage for individuals who have filed claims.

The primary insurance provider covers for the medical expenses takes care of reimbursing for certain benefits while the secondary plans reimburse what the primary plan does not cover.