Coordination of Benefits definition

Coordination of Benefits or “COB” means a provision establishing an order in which plans pay their claims, and permitting secondary plans to reduce their benefits so that the combined benefits of all plans do not exceed total allowable expenses.

Coordination of Benefits means that the benefits provided for you under The Empire Plan are coordinated with the benefits provided for you under another plan. The purpose of coordination of benefits is to avoid duplicate benefit payments so that the total payment under The Empire Plan and under another plan is not more than the actual charge or the reasonable and customary charge, whichever is less, for a service covered under both group plans.

Coordination of Benefits or "COB" means a provision that establishes an order in which insurers pay claims, and that permits benefits paid under secondary plans to be reduced so that the combined benefits paid under all plans do not exceed 100% of the total allowable expenses of the claims.

Examples of Coordination of Benefits in a sentence

• If the other Plan does provide for Co-ordination of Benefits, the following rules are applied to determine which Plan is the Primary Carrier.

• If the other Plan does not provide for Co-ordination of Benefits, it will be considered as the Primary Carrier, and will be responsible for making the initial payment toward the eligible expense.

• Submitting a Claim for Co-ordination of Benefits To submit a claim when Co-ordination of Benefits applies, refer to the following guidelines: Submitting a Claim for Co-ordination of Benefits As per the Order of Benefit Payment section, determine which Plan is the Primary Carrier and which is the Secondary Carrier.

• If the order of benefit payment cannot be determined from the above, the benefits payable under each Plan will be in proportion to the amount that would have been payable if Co-ordination of Benefits did not exist.

• Coordination of Benefits: Voluntary Sick Leave Bank benefits must be coordinated with supplemental sick leave, until an employee is eligible for disability.

More Definitions of Coordination of Benefits

Coordination of Benefits means all activities by which an insurer notifies or is notified by other insurers and/or the Medicaid Program that a claim has been received, for the purpose of establishing primary liability, and/or if previous payment has been made on all or part of the claim.

Coordination of Benefits means that the benefits provided for you under The Empire Plan Prescription Drug Program are coordinated with the benefits provided for you under another group plan. The purpose of Coordination of Benefits is to avoid duplicate benefit payments so that the total payment under The Empire Plan and under another plan is not more than the total allowable charge for a service covered under both group plans.If a covered drug is submitted under the Program, the Program will reimburse the enrollee the submitted balance or the amount that would have been paid as a network benefit under The Empire Plan, whichever is lower. In addition, if you or any of your dependents is covered under two separate Empire Plan policies, you may submit Empire Plan copayments for reimbursement under your secondary Empire Plan coverage using a paper claim form.

Coordination of Benefits means the establishment of a priority between two or more underwriters which provide health benefits protection covering the same claims incident.

Coordination of Benefits or (COB) means the specific requirements (e.g., Medicare Secondary Payer (MSP)) to coordinate other health care coverage (OHC) that is primary to the Member’s CalOptima Program benefits.

Coordination of Benefits means the determination of which two or more Benefit Programs will pay health benefits for a Participant as a primary payor and which will pay as a secondary payor and/or as a tertiary payor.

Coordination of Benefits means that if you or your eligible dependents are covered under more than one Plan, the total amount payable under This Plan, when added to the amount or value of the benefits or services provided by

Coordination of Benefits or "COB" means a provi- sion establishing the order that plans pay their claims, and permitting secondary plans to reduce their benefits so that the combined benefits of all plans do not exceed total allowable expenses.