Coordination of Benefits

What is Coordination of Benefits?

Coordination of Benefits is a practice used by insurance plans to determine how to apply benefit payments when more than one group insurance plan is involved.

When does Coordination of Benefits take place?

Coordination of Benefits takes place when you and/or one of your dependents are covered by more than one group health plan. This may include motor vehicle no-fault or personal injury protection insurance. 

How does Coordination of Benefits work?

TeamCare will coordinate to the total amount the patient is responsible for on a covered expense. TeamCare's policy for Coordination of Benefits is considered Standard. It ensures that the payment of both plans do not exceed 100% of the covered charges. 

Who is primary in Coordination of Benefits when I have two policies through active employment?

When you are the policyholder for more than one policy through active employment, the plan that has covered you the longest is primary. 

Which parent is primary in Coordination of Benefits for covered children?

The plan covering the parent whose birthday (month & day only) falls earlier in the year is primary.

How does Coordination of Benefits work with a Health Maintenance Organization (HMO)?

TeamCare will coordinate benefits provided that the HMO rules are followed.

How is a secondary claim filed to TeamCare?

Providers normally handle the filing of claims. Once the primary carrier has processed the claim, a copy of the itemized bill along with the Explanation of Benefits (EOB) from the primary insurance should be filed according to the instructions on the back of your TeamCare Medical ID card.

I received a request for a copy of my primary Explanation of Benefits (EOB). Where do I send it?

If you received a request from TeamCare for your primary EOB, you may use the Message Center, fax, or mail it to us. Include our member’s ID number (the 806 number) and our claim number, if possible, so we can match up the EOB to the claim.

Does TeamCare coordinate benefits on office visit co-pay?

Yes, unless both primary and secondary coverage are with TeamCare.

Will TeamCare coordinate benefits as secondary for services not covered by a primary insurance plan?

Depending on the primary plan’s rules, TeamCare may consider coordination of benefits if the procedures are normally covered by TeamCare.