COB

The Coordination of Benefits (COB) provision applies when you or your dependents have coverage under more than one health benefit plan. The purpose of coordinating benefits is to avoid duplication of insurance payments. It involves determining which insurer is required to pay benefits as the primary payer, which insurer must pay as the secondary payer, and so on, until all insurers are considered in the correct payment order.

You must inform PEHP of other medical and/or dental coverage in force by completing a duplicate coverage form. If applicable, you may be required to submit court orders or decrees. You must also keep PEHP informed of any changes in the status of the other coverage.

When PEHP is the primary plan, eligible benefits are paid before those of the other health benefit plan and without considering the other health plan’s benefits.

When PEHP is the second plan, PEHP calculates the amount of eligible benefits it would normally pay in the absence of other coverage, including the application of credits to any policy maximums, and applies the payable amount to unpaid covered charges after eligible benefits have been paid by the primary plan. This amount includes deductibles and copayments you may owe. PEHP will use its own deductible and copayments to calculate the amount it would have paid in the absence of other coverage. In no event will PEHP pay more than the member is responsible to pay after the primary carrier has paid the claim. COB will be administered in accordance with Utah Insurance Code, R590-131-5.

For complete information about your PEHP plan, see your applicable Benefits Summary and Master Policy.