Primary Plan
Under coordination of benefits, the plan paying benefits first without regard to other coverage, typically the plan covering the patient as an employee rather than as a dependent.
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Practice This Concept
A married couple is covered by their own separate employer group health plans, and their child is a dependent under both plans. Under the coordination of benefits 'birthday rule,' the child's primary plan is:
The plan of the parent whose birthday falls earlier in the calendar year — Under the coordination of benefits (COB) birthday rule, when a dependent child is covered by both parents' group plans, the plan of the parent whose birthday occurs earlier in the calendar year is primary; the other parent's plan pays secondary benefits. The rule uses the month and day of birth, not the year, so the older parent is not automatically primary. This rule prevents overpayment and sets a predictable order of payment when two group plans cover the same dependent child.
National insurance concept
What is the purpose of a coordination of benefits (COB) provision in group health insurance?
To prevent overpayment when an insured is covered by more than one group plan by establishing which plan pays first and limiting total benefits to actual expenses — COB is designed so that when an insured is covered under two or more group health plans, for example through their own job and a spouse's plan, the plans coordinate so that combined benefits do not exceed actual covered expenses. Standard COB rules identify a primary plan, which pays first, and a secondary plan, which pays the remaining covered amounts up to 100 percent of the allowable expense. This prevents duplication of benefits and keeps premiums lower for everyone in the group, because the insurer can price the plan knowing that double recovery is impossible.
National insurance concept
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