- Participating Physician Groups (PPG)
(does not apply to HSP)
Coordination of benefits (COB) allows group health plans to eliminate the opportunity for a person to profit from an illness or injury as the result of duplicate group health plan coverage. Generally, one plan is determined to be primary, and that plan pays without regard to the other. The secondary plan then makes only a supplemental payment that results in a total payment of not more than the eligible expenses for the medical service provided.
If one plan is an individual plan, not a group plan, both plans pay as primary. The payments do not coordinate.
Participating providers are required to administer COB when such provisions are a requirement of the benefit plans. The participating provider should ask the member for possible coverage through any other group or individual insurance or HMO plan and enter the other health insurance information on the claim.
Contact the Provider Services Department with any information identifying COB coverage for a member.