Receiving Your Benefits

Coordination of Benefits

Many individuals have medical coverage in addition to their coverage under the University’s plans. For example, you may be covered as a dependent under your spouse’s medical plan. This “Coordination of Benefits” provision prevents duplication of benefit payments when you or your Dependent(s) also have coverage through another group plan. Coordination of Benefits procedures also determines which plan pays first.

How Coordination of Benefits Works

The first step in coordinating benefits between two or more group plans is to determine which plan is primary and which plan is secondary. The primary plan pays benefits first. The secondary plan then pays its benefits so that the total benefit paid from both plans is not more than 100% of the allowable expense. No plan pays more than it would pay without Coordination of Benefits. If none of the following apply the plan that covers the patient the longest is primary.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.