Coordination of Benefits
Under the terms of the Network Provider Contract, the Coordination of Benefits (COB) Rules are subject to change. Following is a brief description of the rules that apply to COB:
- With the exception of claims when the primary insurance carrier pays zero, HealthChoice pays the remaining balance on covered charges after the primary carrier payment.
- When the primary carrier pays zero, HealthChoice Allowable Fees, plan deductibles, copays and coinsurance apply for allowed benefits.
- Regardless of the primary carrier’s payment, HealthChoice must deny claims for non-covered services and services that exceed Plan limits. Plan provisions apply.
An unofficial copy of HealthChoice Administrative Rules, which include the COB Rules, is available at https://www.ok.gov/sib/documents/EGIDAdminRules.pdf.