State RegulationsOH specificDifficulty 2/5
What is the primary purpose of a coordination-of-benefits (COB) provision in an Ohio health policy?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
A coordination-of-benefits provision determines which plan pays first and which pays second, so that combined payments do not exceed the allowable expense for the loss. One plan is primary and pays as if the other did not exist, and the secondary plan pays only toward the remaining allowable amount. The Ohio Department of Insurance treats this anti-duplication structure as the point of the provision.
Why the other options are wrong
- A) COB exists to prevent overcollection; total recovery is capped at the allowable expense, not stacked across plans.
- B) Doubling benefits is the opposite of COB's purpose of avoiding duplicate payment.
- C) COB does not forbid multiple coverage; it simply orders payment when multiple coverage exists.
Memory hook
COB = one primary, one backup, no double dip.