Group Insurance

[agentjhc]

I'm not a group/employee benefit agent. So I have a question for you all that are in that line.

At church today I overheard a conversation.

The guy works for a large construction company. Has health insurance on him and dependent coverage/spouse coverage on his wife.

Wife works for Post Office. She has insurance through PO and has her husband on her PO plan.

They indicated that once her plan paid, his would pay the left over and his vice versa.

Does it work that way?

 

[leevena]

Yes. Called coordination of benefits, or cob.

 

[agentjhc]

So it may pay some but not more than reasonable and customary (combined primary and secondary coverage) correct?

They seemed to think it would function like a Med Supp Plan F and pay what the other didn't. COB doesn't seem to function that way.

 

[LostDollar]

They seemed to think it would function like a Med Supp Plan F and pay what the other didn't. COB doesn't seem to function that way.

What do you mean?

(Keep in mind that COB payments will be based on policy definitions of procedures. Medicare supplement coordination with Medicare is defined by the government.)

 

[agentjhc]

EX--after wife's plan pays, husbands plan (she is on his plan as spouse) pay all remaining bills. In other words they think the other health plan will "pay just like a Medicare supplement pays what Medicare doesn't pay". At least based on their comments.

Rather than underlying terms and procedures found in their insurance policies regarding COB.

 

[jaygreen002]

I'm not a group/employee benefit agent. So I have a question for you all that are in that line.

At church today I overheard a conversation.

The guy works for a large construction company. Has health insurance on him and dependent coverage/spouse coverage on his wife.

Wife works for Post Office. She has insurance through PO and has her husband on her PO plan.

They indicated that once her plan paid, his would pay the left over and his vice versa.

Does it work that way?

It basically goes like this: one plan becomes your primary plan. It pays your claims first. Then the second plan may pay toward the remaining cost, depending on the plan.

That process is called coordination of benefits.