The Basics
This is the primary goal of COB: to ensure total payments do not exceed this percentage of the claim.
What is 100%
This rule determines the primary plan for children based on the calendar year.
What is the Birthday Rule
This specific legal document always overrides standard COB rules for children.
What is a Court Decree
This government program is always the "Payer of Last Resort."
What is Medicaid
A secondary carrier cannot process a claim without this document from the primary carrier.
What is an EOB
This plan always pays first, as if no other insurance exists.
What is the Primary Plan
To determine the birthday rule, you look at these two pieces of data, but never the year. (
What are the Month and Day
In the absence of a court decree, this parent’s plan is primary.
What is the Custodial Parent
If an injury happens at a workplace, this insurance must be billed before health insurance.
What is Workers Compensation
This is the math: Total Allowable − Primary Payment = this.
What is the Secondary Responsibility
If a person has a plan through their current employer and a plan as a spouse's dependent, this one is primary.
What is the Member's Employer Plan
If Mom’s birthday is Jan 1 and Dad’s is Jan 1, this parent’s plan is primary if they have had it for 5 years while the other has had theirs for 2.
Who is Mom
If a custodial parent remarries, this person’s insurance usually pays second (after the custodial parent).
What is the Step-parent
For a 68-year-old active employee at a company with 50 employees, this insurance is primary to Medicare.
What is the Employer Group Health Plan
This COB method ensures the member has $0 out-of-pocket as long as the total doesn't exceed the allowable.
What is Traditional Coordination
This term refers to the maximum amount an insurance company agrees to pay for a specific service.
What is the Allowable Expense/Amount
True or False: If a child is over 18 but still a dependent, the Birthday Rule no longer applies.
What is False
This is the payment order for a child with no court decree: Custodial, Stepparent, and finally this person.
Who is the Non-Custodial Parent
A plan for an "Active" employee is always primary over this type of "Inactive" extension coverage.
What is COBRA
This specific COB method only pays what it would have paid as primary, minus what the actual primary already paid.
What is Non-Duplication of Benefits
This is the standard "tie-breaker" rule if two plans have the exact same priority level.
What is Length of Coverage rule
In the order of benefits, a plan covering a person as a "Subscriber" always pays before a plan covering them as this.
What is Dependent
If a court decree says "both parents are responsible," COB defaults back to this rule.
What is the Birthday Rule
This "Fault" or "No-Fault" insurance is primary for medical bills resulting from a car crash.
What is Auto Insurance
If the primary carrier denies a claim for "No Authorization," the secondary carrier usually does this.
What is deny the claim