Health insurance glossary
Coordination of benefits
Plain-English definition
Coordination of benefits is how two health or dental plans that cover the same person share a claim, so that together they pay no more than the eligible cost. One plan pays first, as the primary plan, and the other considers what is left, as the secondary plan. Couples who each have a workplace plan commonly use it to cover more of their costs.
By the HealthRate editorial desk
How it works
Plans follow industry guidelines on which one pays first. Your own plan generally pays first for your claims; for a spouse or children, ask either plan which order applies.
Send the claim to the primary plan first. Then send it to the secondary plan with the primary plan's statement of what it paid.
Each plan applies its own rules, including its own maximums and coinsurance, to the part it considers.
Why it matters
Two plans do not pay twice, but together they can leave much less for you to pay. Sending claims in the right order avoids rejections and delays.
Not to be confused with
Not the same as having two separate policies pay in full. Coordination caps the combined payment at the eligible cost.