If a HealthChoice Plan member is covered by more than one group insurance plan, the
HealthChoice Coordination of Benefits (COB) Rules provide a payment to the Network
Provider from OSEEGIB in an amount that is equal to 100% of OSEEGIB’s standard benefit
(allowed charges) or the member’s liability, whichever is less, when coordinating
benefits among coordinating Plans.
According to HealthChoice COB Rules, HealthChoice Network Providers will not receive
reimbursement from OSEEGIB, in excess of the allowed charge. When the HealthChoice Plan
is other than primary, no additional benefits are payable to the Network Provider, and
the HealthChoice member is not liable for any additional expenses that exceed the
allowed expenses.
An unofficial copy of
HealthChoice Rules, which include the COB Rules, is available from the OSEEGIB
Provider Relations Division.
