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coordination of benefits

Robert M. McCaffery


Coordination of benefits refers to methods for determining primary and secondary responsibility for healthcare expenses when an employee and spouse are both covered by a group benefit plan. Insured plans are governed by state regulations; self‐insured plans are not. In determining which plan is primary, two fundamental rules broadly apply: 1 coverage as an employee is primary to coverage as a dependant; 2 for dependent children the plan of the parent whose birth anniversary occurs first in the year is primary. In determining the amount payable by the secondary plan, several alternative methods may be used. Depending on the method, secondary plan responsibility can range from zero to the entire remaining balance. ( 2001 ). Employee Benefits , 6th edn. Chicago : Dearborn Financial Publishing , pp. 13 – 42 . ( 1992 ). Employee Benefit Programs: A Total Compensation Perspective , 2nd edn. Boston : PWS‐Kent . ... log in or subscribe to read full text

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