Coordination of Benefits and Claims

What this video covers

• Applying the coordination of benefits (COB) rules to determine which plan pays first, including own coverage versus dependent coverage and the birthday rule
• Using the active-versus-retired, ordinary-versus-continuation, and length-of-coverage rules when earlier rules do not decide the order
• Following a claim from the primary plan to the secondary plan, and understanding how each plan applies its own terms
• Calculating a secondary payment cap using the unpaid eligible expense, and recognizing when plans need to reconcile an overpayment
• Distinguishing medical expense reimbursement limits from fixed cash benefits, such as hospital indemnity
• Reading an explanation of benefits (EOB), knowing it is not a bill, and reporting the primary insurer's payment accurately
• Distinguishing coordination of benefits from subrogation and identifying when an insurer may seek recovery from a responsible third party