Which coverage is considered primary when COB is in effect?

When determining which coverage is considered primary under Coordination of Benefits (COB) rules, employer group health plans (EGHP) are typically recognized as the primary payer. This is because EGHPs are designed to provide comprehensive coverage for employees and their dependents, and they often have terms that dictate they take precedence over other forms of insurance.

In situations where an individual has multiple insurance policies, understanding the hierarchy in which plans are paid is crucial for proper claims processing and reimbursement. In contrast, private insurance and Medicaid usually function as secondary payers depending on specific conditions associated with the subscriber’s circumstances and eligibility. As a result, when more than one insurance plan covers an individual, the EGHP generally fulfills the responsibility of the primary payer, ensuring that claims are handled efficiently and effectively.