coordination of benefits


Also found in: Acronyms.

coordination of benefits

a process whereby two or more insurance companies or insuring entities apportion each one's share of the responsibility for payment of a claim for health care services provided to a client who is insured by them.

Co·or·di·na·tion of Ben·e·fits

(COB) (kō-ōr'di-nā'shŭn ben'ĕ-fits)
A clause in insurance policies for patients with more than one carrier to provide a maximum of 100% benefits. One carrier is designated as primary carrier; a second carrier covers any remaining costs not covered by the primary carrier.

co·or·di·na·tion of ben·e·fits

(COB) (kō-ōrdi-nāshŭn benĕ-fits)
Allocation of primary and secondary responsibility when a patient has overlapping coverage by two or more health insurance programs.

coordination of benefits

Insurance policy provisions that govern how benefits for multiply insured parties are to be paid. The total benefits paid from different payers are linked so that the amount paid on behalf of the insured does not exceed the fee for the service provided.

co·or·di·na·tion of ben·e·fits

(kō-ōrdi-nāshŭn benĕ-fits)
Process whereby two or more insurance companies or insuring entities apportion each's share of responsibility for payment of health care claims.
References in periodicals archive ?
Cullinan added that VFW has discussed with Warner the importance of including a "coordination of benefits" between Medicare and Tricare in the final bill.
The financial benefits anticipated from uniform billing, claims processing, coordination of benefits, and other functions are estimated to exceed the costs of implementing the standards by $1.5 billion in the first five years (a net savings of $1.7 billion for health plans, and a net cost of $.2 billion for providers).
The company says other benefits from the program include patient education, coordination of benefits, improved medical outcomes, and lower overall healthcare costs.
Minnesota law requires that the insurance policy "closest to the risk" be primary for purposes of coordination of benefits. If the policy closest to the risk is insufficient to satisfy the liability claim, the secondary policy is triggered for additional coverage.
Under coordination of benefits, combined reimbursement from the two plans is limited to 100 percent of the provider's charge.
"Coordination of benefits" principles allow a secondary payer to reduce payment when a primary payer has already paid for a particular service.
Blue Cross and Blue Shield of Arizona Inc.,(1) in which a hospital patient was covered by two health insurance policies, neither of which had a coordination of benefits clause.
The final agreement includes the employment security and medical benefits provisions of the interim agreement, except where member companies elect to adopt the doctor copayment, drug copayment and generic substitution, pre-certification, and coordination of benefits of the BCOA agreement.
93-04A,(71) the DOL ruled that the New Jersey no-fault law, requiring coordination of benefits between auto insurance and health care plans, may not be interpreted to apply to ERISA welfare plans until the plans receive an advisory opinion from the DOL specifically stating that the New Jersey law is preempted by ERISA.
As with employees who elect to continue their health insurance under the Coordination of Benefits Reconciliation Act, employers now also will have to collect health insurance premiums from employees on leave.
Other strategies include requiring a second opinion before care is given, improving employee awareness of health care benefits costs, and coordination of benefits among multiple coverages.
services include managing enrollment, maintenance of doh~s current pharmacy network, claims adjudication, coordination of benefits and point-of-sale processing services.

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