If You Have Other Coverage
It's possible that your family is covered by more than one health care plan. Your health care plans sponsored by the Company coordinate with any other group health plans for which you are eligible. This process of integrating benefits among two or more plans is called coordination of benefits and applies to most of the health care plans, including each Health Maintenance Organization (HMO). Be sure to contact your health plan to determine if and when it will coordinate benefits.
For most plans except the Mental Health and Substance Abuse Program, if you have more than one group health plan, combined payments under all plans will be provided up to, but not more than, 100% of allowed charges for covered services. Under the Mental Health and Substance Abuse Program, combined payments under all plans will be provided up to, but not more than, the benefits you would receive under this Program alone.
If you are eligible for health care benefits under more than one plan, you should file claims under all the plans for which you qualify.
Here's how coordination of benefits works:
  • One plan will pay benefits first. This is called the primary plan.
  • Then, the other plans for which you qualify — the secondary plans — will pay benefits toward covered expenses left over, if any, after the primary plan pays.
  • You will never be reimbursed for more than 100% of allowed charges for your covered expenses.
Claims should be filed with the primary plan first, then with any secondary plans.
In order to coordinate benefit claim payments, the Claims Administrator needs to obtain certain information either from you or other covered dependents or from other health plan insurers or claims administrators. The Claims Administrator will also need to provide the other health plan insurers or claims administrators with information about you and your dependents' benefit claims. By participating in a Company-sponsored plan, you and your dependents are consenting to cooperate in providing necessary information to the health plan insurers and claims administrators and are consenting to having necessary information released so that all involved claims administrators or health plan insurers can properly coordinate benefits. The claims administrators and health plan insurers coordinate benefits according to the National Association of Insurance Commissioners' (NAIC) guidelines.