Fundamentos de Accidente y SaludPregunta 472 de 716
The 'coordination of benefits' (COB) provision in group health insurance is designed to prevent:
a.The insured from ever filing a claim
b.The insurer from paying any benefits at all whenever a person happens to be enrolled under more than one group plan
c.The plan from covering preventive services
d.The insured from collecting more than 100 percent of covered expenses when covered by two plans
Explicación
Coordination of benefits applies when a person is covered by more than one group plan; it establishes which plan pays first (primary) and which pays second (secondary) so that the total reimbursement does not exceed 100 percent of the actual covered expenses. It does not bar filing claims, block preventive care, or stop the insurer from paying. COB exists to prevent duplicate payment and the profit motive that could arise from being over-reimbursed by multiple plans.
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Revisado por John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verificar)