Understanding My Benefits

We know health insurance can be confusing, whether you have recently purchased a new insurance plan with us or you’re a long-time member. That’s why we’ve assembled all the information you need to know to understand your benefits.

Select a topic below to learn more.

  1. What is coordination of benefits?
  2. How to read your explanation of benefits
  3. Autism coverage FAQ

What’s coordination of benefits?

Sometimes two insurance plans work together to pay claims for the same person. That process is called coordination of benefits. Insurance companies coordinate benefits to:

  • Avoid duplicate payments by making sure the two plans don’t pay more than the total amount of the claim
  • Establish which plan is primary and which plan is secondary—the plan that pays first and the plan that pays any remaining balance after your share of the costs is deducted
  • Help reduce the cost of insurance premiums

When one person has two health insurance plans

You have custody of your 8-year-old son. He’s on your health insurance plan and your ex-husband or ex-wife’s plan. When your son goes to the doctor, the birthday rule applies. What is the birthday rule? Birthday Rule: This is a method used to determine when a plan is primary or secondary for a dependent child when covered by both parents’ benefit plan. The parent whose birthday (month and day only) falls first in a calendar year is the parent with the primary coverage for the dependent. The other parent would be secondary for the dependent child.

That’s coordination of benefits.