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a situation, each member of the family has duplicate and
overlapping health insurance coverage –- coverage under the
father’s plan and coverage under the mother’s plan.
Under COB provisions, in such situations of duplicate and
overlapping health insurance coverage, the various health
insurance companies providing the overlapping insurance coverage
are treated as either primarily or secondarily responsible for
specific expenses and claims based on various and often arbitrary
factors. For example, under COB provisions, medical expenses
incurred by a husband would be treated as the primary
responsibility of the medical insurance plan covering the husband
directly as an employee. The insurance plan of the wife that
covers the injured husband only as the spouse of the wife would
be treated as secondarily responsible for the husband’s expenses.
As a further example, if the two health insurance plans of
the parents cover medical expenses of an injured child only
because the child is a dependent of the parents, under typical
COB provisions, the plan that covers the parent who has the
earlier birthday in the calendar year is treated as having
primary responsibility for the child’s expenses.
Under COB provisions, health insurance companies that are
treated as primarily responsible for medical expenses and claims
(hereinafter referred to as primary insurers) are obligated to
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Last modified: May 25, 2011