Coordinating with other health plans

When you or a family member are covered by more than one health plan, Priority Health uses a system called coordination of benefits to determine how to coordinate with your other plan to pay for your medical services.

Examples:

• You are covered by Priority Health and also your spouse's health plan through his/her employer or by other coverage, such as workers' compensation or auto or homeowners insurance.
• Your spouse is covered by insurance through his/her employer and your Priority Health policy.
• Your children are covered by your health insurer and that of their other parent.
• Someone in your family is covered by Medicare and also has Priority Health coverage to pay for services not covered by Medicare.

Q: How does coordination of benefits work?
Under coordination of benefits:

• One health care plan is named the primary payer and the other is named the secondary payer.
  
• The primary plan pays your medical claims first; the secondary plan pays second.
• We work with the other plan to make sure you receive the benefits covered by your plan, whether your Priority Health plan is primary or secondary.
• We also coordinate benefits for claims covered by auto insurance plans.

Being covered by more than one insurance plan does not guarantee you will not have any out-of-pocket expenses on a medical claim. Your out-of-pocket costs will vary based on the benefits provided by each plan.

Q: How do I report my other coverage?
If you are covered by more than one insurance plan, it is important to:

• Inform your employer or Priority Health if you or any of your dependents are covered by more than one group health plan.
• Provide Priority Health with any documentation that may help determine which health plan is primary, including court orders or other papers.
• Respond promptly to requests from us asking for information about other insurance coverage. This helps ensure your claims are processed promptly.

Contact our customer service department to report your other coverage.

Q: Why does Priority Health need this information?
To ensure:

• We are processing claims in the correct order
• The combined payments from all plans do not add up to more than the covered health care expenses
• There is no double payment of claims

Q: How do I know which insurance plan is primary and which is secondary?
There are many factors that determine the order of coverage. To determine if your Priority Health plan is your primary or secondary plan, contact our customer service department.

To learn more about coordination of benefits, see your online Certificate of Coverage (COC) or insurance policy. See the standard coverage documents.