Process a dual coordination of benefits (COB) claim

Some members have a spouse working for the same fund/group and are covered by the same insurance plan. Their claims need to be processed under the primary member’s record, then the line item payments need to forward as the COB A provision for determining benefits when a member has more than one benefit plan. amounts for the secondary claim under the secondary claimant spousal record.

The status operator will show as DUAL.
Depending on your system, dual COB claims might create automatically for members that have coverage under their spouses records as well their own coverage with the same company. Contact your administrator for support.

If you press , a message asking if you want to create the Supplemental claim displays. Click No.
1. The dual COB claim is created, and a message displays in the navigator, A Dual COB claim has been created. See <Refno>.
2. A blank claims screen displays with the Refno for the primary claim in the Last Refno field.
If you enter a Refno to link the claim and , a message displays asking if you want to create the Supplemental claim. Click No.
1. The dual COB claim is created and a blank claim screen displays with the Refno for the primary claim in the Last Refno field.

Depending on your system settings or the claim, the following messages could display when you save.

Dual COB Coverage exists. Please review
If you save a claim when referrals have been used, you'll receive the following message:Review applied referral(s).
If you save a claim with referrals that are or will be over applied, you'll receive the following message: Continuing to save will overapply referral(s).