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What does coordination of benefits mean? When someone is covered by more than one benefits plan, the plans work together to pay any claims.
Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an
Having access to two health plans can be good when making health care claims. Having two health plans can increase how much coverage you get. You can save money on your health care costs through whats known as the coordination of benefits provision.
The plan that pays second calculates benefits for each individual item on the claim, based on the lowest of: The amount that would have been payable had it been the first plan, or 100% of the eligible expenses minus the benefits paid by the first plan.
Calculation 1: Add together the primarys coinsurance, copay, and deductible (member responsibility). If no coinsurance, copay, and/or deductible, payment is zero. Calculation 2: Subtract the COB paid amount from the Medicaid allowed amount. When the Medicaid allowed amount is less than COB paid, the payment is zero.
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Members can make changes to their coordination of benefit information by: accessing the claims section of the Plan Member Services website at .sunlife.ca/member, contacting our Call Centre, or. using the claims submission process.
This Coordination of Benefits (COB) Questionnaire contains questions about other forms of medical insurance you have. COB helps to ensure that members covered by more than one plan will receive the benefits they are entitled to while avoiding overpayment by either plan.

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