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Texas, Inc., the common parent of petitioner’s affiliated group,
maintained its principal place of business in Richardson, Texas.
Hereinafter, petitioner will be referred to simply as Blue Cross.
Coordination of Benefits Provisions
Since the 1970's, medical health insurance plans written by
Blue Cross and by other health insurance companies typically
contain nearly identical “coordination of benefits” (COB)
provisions that are based on COB guidelines published by the
National Association of Insurance Commissioners and that are
required by most State insurance laws. The COB provisions
establish payment responsibility, as between two or more health
insurance companies, where insurance claims are filed that are
covered by more than one health insurance company. The COB
provisions are intended to prevent duplicate recovery on claims
with respect to the same medical expenses.
COB provisions are applicable where medical expenses are
incurred by individuals who are covered under two or more health
insurance plans. A common COB situation arises in a family
context where both parents are employed, with one parent covered
by one group health plan and the other parent covered by another
group health plan, with the spouse of each parent and each child
also covered by both of the parents’ group health plans. In such
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Last modified: May 25, 2011