What is Coordination of Benefits (COB)?

Coordination of Benefits (COB) is when two insurance plans work together to pay claims for the same person. This occurs when you or your dependents are covered for benefits under more than one insurance plan.

How it works

There are three main scenarios when coordination of benefits comes into effect:

Scenario 1: You're covered under your own insurance plan with your employer, and covered as a dependent under your partner’s plan;
Scenario 2: Your partner is covered under their own insurance plan with their employer, and covered as a dependent under your plan;
Scenario 3: Your dependent child(ren) has coverage under both your and your partner’s insurance plans.

In all scenarios there is a primary payor and secondary payor, which determines whose insurance plan you should submit a claim to first.

Scenario 1

You have coverage under your own insurance plan and under your partner’s plan:

The primary payor is always your own insurance plan;
The secondary payor is your partner’s insurance plan.

This means you’ll submit a claim to your own insurance plan first. If your insurance plan doesn’t cover the full claim amount you can submit the claim to your partner's insurance plan, with the explanation of benefits statement, and request payment for the remainder of the balance.

Note: When submitting a claim to your partner's insurance, you may not be reimbursed for the entire remaining balance. This will depend on the amount of coverage offered by your partner's insurance plan.

Example: You have a massage appointment. You submit the claim to your insurance plan, which covers 80%. You can then submit the claim to your partner's plan, with the explanation of benefits statement, for the remaining 20% balance.

Scenario 2

Your partner is covered under their own insurance plan and under your plan:

The primary payor is always your partner's insurance plan;
The secondary payor is your insurance plan.

This means your partner will submit a claim to their own insurance plan first. If their insurance plan doesn't cover the full claim amount they can submit the claim to your insurance plan, with the explanation of benefits statement, to request payment for the remainder of the balance.

Note: When submitting a claim to your partner's insurance, you may not be reimbursed for the entire remaining balance. This will depend on the amount of coverage offered by your partner's insurance plan.

Example: Your partner has a physiotherapy appointment. They submit the claim to their insurance plan, which covers 70%. They can then submit the claim to your plan, with the explanation of benefits statement, for the remaining 30% balance.

Scenario 3

Your dependent child(ren) has coverage under both your and your partner’s insurance plans:

The primary payor is the insurance plan of the parent with the earliest birthday in the calendar year (not the earliest birth year);
The secondary payor is the insurance plan of the parent with the latest birthday in the calendar year.

Example: Your birthday is Feb 1st, 1980. Your partner’s birthday is Jan 1st, 1985.

The primary payor for all your child(ren)’s claims will be your partner’s insurance plan, because your partner has the earliest birthday in the calendar year. The year of birth isn’t taken into account.

If both parents have the same birth date:

The primary payor is the insurance plan of the parent whose given name occurs first in the alphabet.
The secondary payor is the insurance plan of the parent with the given name that occurs last in the alphabet.

Example: Your name is Avery and your partner’s name is Drew.

The primary payor for all your child(ren)’s claims will be your insurance plan, because your name occurs first in the alphabet.

Alternate Scenarios

There are two main scenarios when a coordination of benefits won't follow the normal rules:

You're separated from your partner and have a child(ren) together: The primary payor for your dependent child(ren) is the insurance plan of the parent with primary custody.
Your child(ren) has coverage through their school: The primary payor for your dependent child(ren) is their own insurance plan. The secondary payor will be the insurance plan of the parent with the earliest birthday in the calendar year.

How does COB work with spending accounts?

All League Lifestyle Spending Account (LSA) or Health Spending Account (HSA) claims must first be submitted to an insurance plan (both your primary and secondary payors, if applicable). You can then submit the remaining balance against a spending account for reimbursement.

Learn more about coordinating your benefits with a spending account.