Blue Cross & Blue Shield of Texas, Inc. and Subsidiaries - Page 4




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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