Coordination of Benefits is a common provision in most benefit plans. It applies when a member has more than one health coverage plan in effect at the time services are rendered. Specific, industry-wide rules exist for most plans determining which plan pays first (PRIMARY) on these expenses and which plan pays next (SECONDARY).

Additional rules for most plans in determining which plan pays first are, generally:

• For YOUR health expenses, YOUR plan pays before your spouse's. Medicare usually pays first, if you are not covered by a plan through someone's active employment.
  
  
• The plan of the spouse who has the earliest birthday in the year pays first on children. If two carriers can't agree on who pays first, the coverage which has been in effect the longest pays first.
  
  
• The above points are general and coordination rules are complicated and may depend on a number of factors. You should check with your plan book for case specific situations.
  

Some TIPS on how to sort through the rules are:

• READ YOUR PLAN DOCUMENTS and get a good understanding of what they mean. Speak with your employer or customer service representative if it gets confusing.
  
  
• Don't be disappointed if the combination of all your coverages doesn't pay more than the amount of the original bill. Your health coverage was designed to help with your health care expenses, not provide extra income.
  
  
• In some instances, a person may have three plans in effect at the same time. This is common for persons who become Medicare eligible while their spouse is still actively employed. In this instance, the actively employed spouse's plan pays first (because federal law requires it), the retiree's Medicare coverage pays second. Then, benefits sponsored by the retiree's employer pays third (TERTIARY), after Medicare.

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