What is a COB?

Coordination of Benefits (COB) is a process used in health insurance to determine primacy if you have dual insurance coverage.  This information helps determine which policy pays as primary and secondary on a claim. This situation often arises when an individual has coverage under more than one source, such as through a spouse’s employer or public health programs. The primary goal of COB is to prevent overpayment for healthcare services and to streamline claims processing.

To get a Coordination of Benefits (COB) statement or to understand your COB situation, follow these steps:

1. Check Your Insurance Policies: Review your health insurance documents to see if they include COB clauses. This information can often be found in the policy or benefits handbook.

2. Contact Your Insurers: Reach out to the member service departments of both your primary and secondary insurance providers. They can provide details about how COB applies to your coverage.

3. Provide Necessary Information: Be prepared to share information about both insurance plans, such as policy numbers, coverage details, and the names of insured individuals.

4. Fill Out a COB Form: Some insurers may require you to complete a COB form to officially declare that you have dual coverage or to declare that you do not have dual coverage. This form helps them determine the primary and secondary payer as applicable.

5. Keep Records: Maintain copies of all communications and documents related to your insurance coverage, as this will help if you have to resolve any claims issues later on.

6. Consult HR or Benefits Administrator: If you have employer-sponsored insurance, your HR department or benefits administrator can also provide guidance on how COB works in your situation.

COB is designed to prevent duplicate payments, meaning you can only recover up to the total cost of your medical expenses. However, by effectively utilizing both plans, you can potentially reduce your out-of-pocket expenses, as the secondary insurance may cover remaining eligible costs after the primary insurer has paid.

Coordination of Benefits is regulated by various laws, including the Health Insurance Portability and Accountability Act (HIPAA), which safeguards patient privacy and outlines rights related to health insurance. 

Since HealthJoy is not your insurance provider, we have limited access to your Insurance Benefits and cannot update the Coordination of Benefits for you. Please contact your insurance carrier directly by calling the number on the back of your insurance card.