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Benefits 101: The Coordination of Benefits Questionnaire

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What is “Coordination of Benefits?”


Coordination of Benefits (COB) is the practice of ensuring that medical claims are processed first by the health insurance plan that has primary responsibility for them. COB also works to make certain that claims are not covered or paid for more than 100% of their value once all medical plans have processed them. 

COB is an appropriate financial management practice that helps contain costs and ensures that the right medical plan takes initial responsibility for eligible claims.

Insurance companies coordinate health care benefits to determine which plan is primary and which is secondary. The primary plan pays the claim first and the unpaid balance can then be submitted to the secondary plan which may pay more of the charge. Benefits are coordinated between the two health plans to ensure that each patient receives full, but not excess, coverage.


Coordination of Benefits At Lehigh

This coming year, Lehigh will be stepping up its COB efforts. This means that if you have dependents covered by Lehigh’s medical insurance plan, you will be asked to complete a Coordination of Benefits questionnaire.

The form, which you will receive from Capital BlueCross, will ask you a number of questions, including:

  • Does your spouse/partner also have coverage for your dependents on a plan from his or her employer?
  • What is the birthday (month and day) of the other spouse/partner who provides coverage to your dependents?
  • Is there a non-custodial parent who is directed to cover the children on his/her medical plan as part of a custody agreement?
You can expect to see your Coordination of Benefits questionnaire in mid-January of 2013. If you receive the questionnaire, it’s essential that you complete and return it as quickly as possible. If you don’t, your insurance claims could be rejected or delayed until you do.

The Birthday Rule

You may be wondering why we need the birthday of the spouse/partner/parent who also has your dependents on his or her medical insurance plan. In general, spouses/partners receive primary coverage from the medical plan that covers them as an employee. But how do we determine whose plan is primary for dependents?

The answer is the birthday rule:


Dependent children receive primary coverage from the parent whose birthday comes first in the calendar year. Secondary coverage comes from the medical plan of the other employer, or the other parent, respectively.

The birthday rule is accepted practice among employers nationwide.

Questions?

If you have any questions about Coordination of Benefits or the questionnaire, feel free to contact Tim Hinkle in HR at th09@lehigh.edu or extension 85167.

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Spotlight is published monthly by Human Resources. Please address any comments to Hillary Kwiatek, Spotlight Editor, Human Resources, 428 Brodhead Avenue, send email to hik210@lehigh.edu, or call extension 85165.

Current and past issues of Spotlight can be viewed and searched at: Past Issues.