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There is no court decree, but you have custody of the child. You are separated or divorced and you have informed us of a court decree that makes you responsible for the child’s health care expenses You are married and your birthday is earlier in the year than your spouse’s or you are living with another individual, regardless of whether or not you have ever been married to that individual, and your birthday is earlier than that other individual’s birthday.
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The claim is for the health care expenses of your child who is covered by this plan and The claim is for your spouse, who is covered by Medicare, and you are not both retired. The claim is for your own health care expenses, unless you are covered by Medicare and both you and your spouse are retired. If you or a family member are covered under another plan in addition to this one, we will be primary when: Your own expenses The primary plan always pays first when you have a claim.Īny plan that does not contain your state’s COB rules will always be primary. We need this information to determine whether we are the “primary” or“secondary” benefit payer.
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You will be asked to identify all the plans that cover members of your family. If your situation is not described, read your evidence of coverage or contact your state insurance department. This is only an outline of some of the most common ones. The goal is to make sure that the combined payments of all plans do not add up to more than your covered health care expenses.Ĭoordination of benefits (COB) is complicated, and covers a wide variety of circumstances. When you are covered by more than one health plan, state law permits your insurers to follow a procedure called “coordination of benefits” to determine how much each should pay when you have a claim. This happens, for example, when a husband and wife both work and choose to have family coverage through both employers. It is common for family members to be covered by more than one health care plan. This is not a complete description of all of the coordination rules and procedures, and does not change or replace the language contained in your insurance contract, which determines your benefits. This is a summary of only a few of the provisions of your health plan to help you understand coordination of benefits, which can be very complicated.