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60 11/2005
Coordination of Benefits
If the member’s BCBSGa/BCBSHP coverage is secondary to some other primary
insurance, BCBSGa/BCBSHP will coordinate the payment of benefits with the primary
carrier’s payment according to the following guidelines:
1. Coordinating Benefits with Other Health Care Plans – If a member or his/her
eligible dependents have duplicate coverage under another BCBSGa group
program, any other group medical expense coverage, or any local, state or
governmental program (except school accident insurance coverage and
Medicaid), then BCBSGa/BCBSHP benefits will be coordinated with the benefits
payable under the other program. The total benefits paid by both programs
will not exceed 100% of the provider’s eligible (contracted) reimbursement
amount.
2. Automobile Insurance – Benefits available through automobile insurance
coverage will be determined before that of any other program.
3. Non-dependent/Dependent – The benefits of the program which cover the
person as an employee are determined before those of the program which
covers the person as a dependent.
4. Dependent Child/Parents Not Separated or Divorced – Except as stated below,
when the BCBSGa/BCBSHP program and another program cover the same child
as a dependent of different persons, called “parents”:
• The benefits of the program of the parent whose birthday falls earlier in a
year are determined before those of the program of the parent whose
birthday is later in the year.
• If both parents have the same birthday, the benefits of the program which
covered the parent longer are determined before those of the program which
covered the other parent for a shorter period of time.
However, if the other program does not have the rule described above, but
instead has a rule based on the gender of the parent, and if, as a result, the
programs do not agree on the order of benefits, the rule in the other program
will determine the order of benefits.