If You Have Other Coverage
If you and your spouse/registered domestic partner both work, it's possible that your family is covered by more than one health care plan. The process of integrating benefits among two or more plans is called coordination of benefits.
If you are enrolled in the Anthem Health Account Plan (Anthem HAP), Anthem Blue Cross will coordinate benefits with any other group health plans for which you are eligible. This means the Anthem HAP will pay benefits on a secondary basis if any of your enrolled dependents have primary medical coverage elsewhere. Be sure to contact Anthem Blue Cross to determine if and when it will coordinate benefits on a secondary basis.
The PG&E Kaiser Permanente HAP (KPIC HAP) does not coordinate with any other Kaiser Permanente plan. If you or your dependents have coverage under the PG&E KPIC HAP and you also have coverage under another Kaiser Permanente plan through your spouse or parents, no additional benefits will be paid once Kaiser has paid benefits under the plan that is primary. There is no advantage to having dual coverage with Kaiser if you are enrolled in the PG&E KPIC HAP. In addition, if you have double coverage with a non-Kaiser plan, your PG&E KPIC HAP will not pay benefits on a secondary basis if you use non-Kaiser network providers. (There are limited exceptions in which Kaiser may coordinate benefits with another non-Kaiser plan — for example, when Kaiser refers you to a non-network provider for specialized treatment which cannot be provided by Kaiser providers. Contact Kaiser Permanente for more information.)
For most plans that coordinate benefits, with the exception of the HAP's mental health and substance abuse benefits provided by ValueOptions, combined payments under all plans will be provided up to, but not more than, 100% of allowed charges. For the HAP's mental health and substance abuse benefits provided by ValueOptions, combined payments under all plans will be provided up to, but not more than, the benefits you would receive from ValueOptions 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 HAP 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.