Coordination of benefits (COB)

When more than one insurance plan could potentially cover your medical expenses, one plan usually pays its benefits in full as the primary payor and the other plan pays a reduced benefit as the secondary payor.

APWU Health Plan uses guidelines from the National Association of Insurance Commissioners (NAIC)(external link) to determine which coverage is primary.

What is coordination of benefits?

Coordination of benefits (COB) is the process insurance companies use to decide who is responsible for covering the cost of your care when two insurance plans are working together to pay the same claim.

COB helps insurance companies:

• Establish which plan is primary and which is secondary
• Avoid duplicate payments
• Make sure two plans don’t pay more than the total amount of the claim
• Help reduce the cost of health insurance premiums

Coordinating benefits with Medicare and other coverage

Section 9 of the federal brochure provides detailed information about the process APWU Health Plan uses to coordinate benefits with Medicare and other types of insurance. You can find COB details for how your claim will be handled in a range of situations:

• When you have other health coverage
• When other government agencies are responsible for your care
• When others are responsible for injuries
• When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP)
• When you have Medicare

Contact APWU Health Plan with questions about coordinating your benefits

Navigating the healthcare system can be confusing. The customer service team at APWU Health Plan is here to answer your questions and clarify the process, so you can be sure you have the coverage you need.

To speak with a customer service representative, call: