Commercial
This is a rule used to determine whose insurance is primary for a child that is covered under both parents' insurance.
What is the Birthday Rule?
These types of plans are referred to as the insurance of last resort.
MA and MAHMO plans.
What type of insurance fills in the 20% co-insurance 'gap' for Medicare patients?
What is a Medicare Supplement?
These types of plans are considered the payer of last resort after Medical Assistance.
What are non-insurance payers- programs and funds.
This is the COB for a patient who is covered by Capital Blue but is also covered by their spouse's Highmark Blue Shield insurance.
What is Capital Blue primary and Highmark Blue Shield secondary?
Auto or Worker's Comp plans are loaded in this COB with a patient's health insurance.
What is Auto or Worker's Comp primary followed by the patient's health insurance secondary?
A patient is 70 and retired with Medicare. They are also covered by their working spouse's Cigna Insurance. The spouse's work has 90 employees. This is the COB.
What is Cigna primary and Medicare secondary?
This health plan does not follow the birthday rule.
What is Tricare?
A child is covered by his mother's insurance, BC Independence. Mom's birthday is 09/10/70. The child is also covered by his father's Tricare. Dad's birthday is 01/10/70. This is the COB.
What is BC Independence primary and Tricare secondary?
A patient is being seen for an auto accident and they have an auto claim. The patient also hands you a Medical Assistance card and a Highmark WholeCare Gateway Medicaid card. This is the COB.
What is Auto primary and Highmark WholeCare Gateway Medicaid secondary?
A 72 year old patient presents a Humana Gold card, a Medicare card, and a AMHL CHC card. This is the COB.
What is Humana Gold primary and AMHL CHC secondary?
A patient was referred by the VA. He is 75 and has Medicare, Highmark Supplemental, and VA coverage. This is the COB.
What is VA coverage primary, Medicare secondary, and Highmark Supplemental tertiary?
A child has Geisinger coverage through her father's work, her father's DOB is 08/20/78. The child also has Humana coverage through her mother's work, her mother's DOB is 02/15/80. This is the COB.
What is Humana primary and Geisinger secondary?
A patient is being treated for a work injury. They also hand you a Blue Journey card and a Medicare card. This is the COB.
What is Workers Comp primary and Blue Journey secondary?
A patient is 66 with Medicare but also has United Healthcare through their work at a local furniture shop that has 12 employees. This is the COB.
What is Medicare primary and United Healthcare secondary?
A child has the Chronic Renal Disease Program. They also have Geisinger Family as well as Highmark coverage, through their father's work. This is the COB.
What is Highmark primary, Geisinger Family secondary, and Chronic Renal Disease Program Program tertiary?
A child is covered by both of their parents' GHP plans through their employers. Mom’s birthday is 07/04/70 and she has Highmark PPO Blue and Dad's birthday is 10/20/68 and he has Capital Blue Cross. The child also has UPMC for You. This is the correct COB.
What is Highmark primary, Capital Blue secondary, and UPMC for You tertiary?
Two examples of non-insurance payers.
What is FAP, Chronic Renal Disease Program, Milton Hershey School, Four Diamonds?
A 30 year old patient has Medicare due to disability. They also have Aetna coverage through their spouse's work at Target. This would be the COB.
What is Aetna primary and Medicare secondary.
An ESRD Medicare patient is currently on dialysis and they have Aetna coverage through their current employer. What is the COB after the 30 month coordination period?
Medicare primary and Aetna secondary.