If you have two or more health insurance policies in force (dual coverage – secondary insurance) – which one pays 1st?
Co-ordination of Benefits(COB)?
The best most authoritative answer will be in the Evidences of Coverage (EOC). Here’s an excerpt from a employer Group United Health Care policy. Request an EOC from YOUR insurance Agent or HR Department.
See below for other links and official brochures.
Generally, Individual Policies do NOT have a Co-Ordination of Benefits Clause. Blue Cross PPO has one, ONLY if you have another Blue Cross policy. Page 142 Specimen Policy On the other hand, when you apply, the Insurance Company, might ask if you have other coverage. In Group Policies are COB clauses are permitted, but cannot co-ordinate against Individual Policies. CA Code 10270.98
Brochures, Links & Resources with the EXACT answers!
Medicare Guide to who pays first # 02179
NAIC Summary on Co-Ordination of Benefits
Employer Health Policy – Specimen – COB Rules
Medicare Guide to Rx Coverage Publication 11109 See Section 4
Our website on Medicare Rx Drugs
Health Care Reform Dependent Coverage vs Spousal Coverage
National Association of Insurance Commissioners – Model Regulation 64 pages
One page summary
How about an HSA (Health Savings Account) rather than buying extra policies?
There might be some cases where a COB provision is not allowed – like HIPAA policies for when COBRA ends.
Individual Plans cannot have this clause per CCR §1300.67.13 b 2 d BUT, they might require that you cancel other coverage. Blue Cross EOC Page 5
With COBRA protections and HIPAA availability when you lose Group Insurance, it probably is no longer necessary to keep an individual plan, “just in case.” The extra premium, would probably be better spent on Life or Disability Insurance.
Life Insurance does not have a co-ordination of benefits clause. They will ask on the application though if you have other coverage to prevent over insurance and to make sure there is insurable interest.
See also Balance Billing
What if your doctor charges more than the negotiated rate?
- COBRA and Spousal Coverage – Two inforce policies – Web Vistor Q & A
- COBRA, Donald Care & Dual Coverage – Web Vistor’s Question
Coordination of Benefits Agreement Index Coordination of Benefits Agreement CMS.Gov
Subrogation if you get in an accident and someone else can be sued
TITLE 28. MANAGED HEALTH CARE
Can a husband & wife have coverage from each of their employers?
What if you are divorced?
If they have coverage from one employer, can the other one refuse coverage through their work?
It is not generally up to you to decide which policy pays 1st. The rules under most circumstances are below. Why not just turn in the claim to all relevant policies and let them sort it out?
What are the co pays?
Can you collect more than your actual medical expenses?