Coordination of benefits (COB)

When employees have multiple insurance plans, you need to make sure the correct plans are making payments, this is referred to as coordination of benefits (COB A provision for determining benefits when a member has more than one benefit plan.). COB policies create a framework for the two insurance companies to work together to coordinate benefits so they pay their fair share. COB decides which is the primary plan and which one is secondary. The primary plan pays its share of the costs first. Then, the secondary insurer pays up to 100% of the total cost of care, as long as it's covered under the plans. The plans won't pay more than 100% of the treatment cost.

A retiree has health insurance with a former employer and Medicare.
An individual has health insurance through her spouse’s employer as well as her own employer.
A dependent child has health insurance under both parents.

Use the COB menu to record and track Medicare and other insurance information to pay claims correctly. Access this function from the star menu during claims processing or claims entry, or from the Claims menu in either a member or dependent session.

The Coordination of Benefits table lists the available insurance coverages. Select a row in the table to see the insurance coverage details.

Note: Your screen might not have the same fields as the example, depending on your configuration.

COB Field Descriptions

* indicates a required field

Field	Description
From Date*	The date of the other insurance coverage is in effect. Click and select a date or enter a date in `MM/DD/YYYY` format.
Thru Date	The termination date of the other insurance coverage.
Carrier*	The organization that issued the insurance policy. Select a carrier from the list.
Phone	The carrier's phone number. Enter any alphanumeric or non-alphanumeric characters.
COB Employer	The employer associated with the benefit plan offering. This is a free-form text field to show the employer, but there is no validation on spelling or verification the employer is in the system. This information won’t display anywhere else.
Comments	Additional information associated with the insurance coverage. Any comment text longer than 30 characters will wrap and show in the text box.
Group	The group or employer name. Enter any alphanumeric or non-alphanumeric characters.
Policy	The policy number for the healthcare coverage. Enter any alphanumeric or non-alphanumeric characters.
Plan Type	The claim benefit plan type (e.g. medical, dental or vision).
Level	The insurance plan order to pay the claim. The primary health insurance is the plan that pays the claim first, as if it were the only source of health coverage. Then, the secondary insurance plan picks up the cost left over after the primary plan has paid the claim. `P`—Primary `S`—Secondary `T`—Tertiary
Covered Dependents	The table lists each member of the family. `Name`—The name of the individual. `Relation`—The relationship to the dependent (e.g. Member, Spouse, Child). `Gender`—The individual's gender (M—male, F—female or U—unknown). Select unknown if you don't know the gender. Update the record once you do know. `Date of Birth`—The individual's birth date. `Covered`—A check mark indicates the individual is covered by this insurance policy. You must select at least one individual. Dual COB Primary and secondary coverage claims that are processed by the same fund office. fields (displays based on system configuration) `Second ID`—The policy SSN for the secondary claim. If your system is configured for masking and is turned on, it will be masked. `Sec Depno`—The dependent number of the secondary covered dependent. When you enter the SSN into the `Second ID` field, the `Sec Depno` defaults to that dependent's number. `Auto-create`—Override automatic creation for a secondary claim. The claim will need to be processed manually
Review Information	Text that shows and the date and the operator ID of the person who last reviewed (clicked ), updated, or deleted the COB information.

Learn how to manage and process COB: