What does the coordination of benefits provision do?

The coordination of benefits provision is designed to manage how multiple insurance policies work together when a policyholder has coverage from more than one insurer. The primary purpose of this provision is to ensure that the total claims paid from all insurers do not exceed the allowable medical expenses incurred.

This means if an individual has coverage from multiple health insurers, the coordination of benefits provision will determine the order in which each insurer pays its share of the claim—one will be the primary insurer, and the others will be secondary. The total amount received from all insurers will not exceed the actual medical expenses incurred, thus preventing overpayment for the same service or treatment.

By limiting total claims paid to allowable medical expenses, this provision promotes fairness and prevents fraud while ensuring that claimants can receive the full benefits they are entitled to based on their medical needs.