When you have your first claim of the year for either medical or dental, do you ever wonder why you receive a letter asking if you and/or your dependents have other insurance coverage? If so, then it’s probably because at open enrollment you did not complete the Coordination of Benefits Form. This form is required if you have elected medical and/or dental coverage with NMC. After you complete this form, it is sent to Meritain Health, who in turn sends it on to Priority Health if you elected medical and to ASR if you elected dental.
Coordination of benefits (COB) is the practice of ensuring that insurance claims are not paid multiple times, when an enrollee is covered by two health plans at the same time. The idea behind coordination of benefits is to ensure that the payments of both plans do not exceed 100% of the covered charges. The provision coordinates the health care benefits in the order in which the multiple health plans must pay benefits. Under a COB provision, insurance companies share the burden without overpaying. COB determines which plan is primary and which is secondary. The primary plan will pay the claims first and the unpaid balance will be paid by the secondary plan to the limit of its responsibility. Benefits are coordinated between the two health plans to ensure that policyholder receives full coverage. However over insurance or excess coverage is not permitted under COB.
If you didn’t complete the Coordination of Benefits form at the time you did your open enrollment, click on the link above to access the form so you can complete and submit it to Meritain Health. If you have any questions, feel free to contact HR at 995-1362.