Coordination of
benefits (COB) applies to members who are covered by more than one health care
plan. 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. Coordinating benefits is one of the ways to keep premiums at a
minimum.
When
You Are Covered by UC SHIP and Another Health Plan
When a member of
the UC SHIP is covered by more than one health plan (for example, when a student
is covered under the SHIP plan, as well as a spouse's or parent's health plan),
one plan is considered to be the primary carrier and the other is considered to
be the secondary carrier. The primary carrier covers the major portion of the
bill according to plan allowances, and the secondary carrier covers any
remaining allowable expenses.
For services
received outside of the Student Health Services, the student's other medical
plan will be considered the primary plan, meaning that plan must consider claims
first. After the primary plan processes and pays a claim or denies liability,
any remaining charges may be submitted to UC SHIP (the secondary plan) for
consideration of plan benefits. This holds true for all medical plans except
the Medical Risk Management Insurance Program (MRMIP), Medi-Cal, and TriCare.
If a student has MRMIP, Medi-Cal or TriCare, UC SHIP will be the primary plan,
and MRMIP, Medi-Cal or TriCare the secondary plan. For questions about
coordination between plans, call Anthem Blue Cross Customer Service at
1-866-940-8306.
The COB provisions of
your policy or plan determine which plan is primary. The plan's benefits are
applied to the claim first. The unpaid balance is usually paid by the secondary
plan to the limit of its responsibility. Benefits are thus "coordinated" among
all of the health plans, and payments do not exceed 100 percent of charges for
the covered services.
Please complete the
Coordination of Benefits Questionnaire and submit to
Anthem.