Duplicate Plan Coverage
- Participating Physician Groups (PPG)
If a member is covered by more than one group plan and is enrolled with a single participating provider, all copayments must be waived for eligible services.
In addition, when coverage states a maximum number of visits, the member is entitled to the number of visits in the plan that covers the most. For example, if one plan covers 20 visits and the other 50 visits, the member's coverage is limited to 50 visits.
If the member is covered by more than one group plan and is enrolled with two different participating providers, coverage is determined by applying coordination of benefits (COB) rules. Applicable copayments are required from the member.