Human Resources Coordination of Benefits Q & A
Q. Coordination of benefits (COB) is confusing. Can you provide some examples for dual coverage with medical plans so I can get a better understanding of how benefits will be coordinated?
A. The Moda Health website contains many examples covering a wide variety of scenarios to help you understand how claims are processed when you are covered under more than one medical plan. After reading these examples, if you need further questions, please contact your medical carrier(s) directly for personalized assistance.
A. The Moda Health website contains many examples covering a wide variety of scenarios to help you understand how claims are processed when you are covered under more than one medical plan. After reading these examples, if you need further questions, please contact your medical carrier(s) directly for personalized assistance.
Q. When an OEBB member has dual OEBB coverage, does the deductible have to be
satisfied or will it be picked up by the other plan?
A. The deductible still must be satisfied prior to any benefit reimbursement. For example, if a member is dual covered under OEBB's Moda Health Medical Plan C, there is a $500 deductible that must be met.
The following is an example of how this would work: Moda Health receives a claim with eligible charges of $520; $500 is applied to the primary plan's deductible. Moda Health would reimburse the provider 80 percent (assuming the service was in-network and not a copayment service) of the remaining balance of $20, which equals $16. Moda Health would then apply the same $500 to the secondary coverage's deductible. Moda Health would pick up the additional $4 of eligible charges, which was not applied to the deductible, as the secondary carrier. Total member responsibility for this claim - $500.00. Deductible is now satisfied on both plans.
A. The deductible still must be satisfied prior to any benefit reimbursement. For example, if a member is dual covered under OEBB's Moda Health Medical Plan C, there is a $500 deductible that must be met.
The following is an example of how this would work: Moda Health receives a claim with eligible charges of $520; $500 is applied to the primary plan's deductible. Moda Health would reimburse the provider 80 percent (assuming the service was in-network and not a copayment service) of the remaining balance of $20, which equals $16. Moda Health would then apply the same $500 to the secondary coverage's deductible. Moda Health would pick up the additional $4 of eligible charges, which was not applied to the deductible, as the secondary carrier. Total member responsibility for this claim - $500.00. Deductible is now satisfied on both plans.
