Coordination of benefits with other insurance
When you or a family member are covered by more than one health plan, Priority Health uses a system called coordination of benefits to determine how to coordinate with your other plan to pay for your medical services.
Examples:
- You are covered by both Priority Health and your spouse's health plan
- Your children are covered by your health insurer and that of their other parent
- You are covered by Medicare and have Priority Health coverage to pay for services not covered by Medicare
Primary and secondary payers: How companies coordinate benefits
Under coordination of benefits, one health care plan is named the primary payer and the other is named the secondary payer. The primary payer pays your medical claims first; the secondary payer pays second.
- We work with your other plan to make sure you receive the benefits included in your plan, whether your Priority Health plan is primary or secondary.
- We also coordinate benefits for claims covered by auto insurance plans.
- If the amount we pay is more than we should have paid, we have the "right of recovery" to recover extra payments from the other companies or your health care providers. You must cooperate with us in these recoveries.
- If you are paid for any services both by us and by another company, we have a right to be reimbursed by you for that overpayment.
Being covered by more than one insurance plan does not mean you will have $0 out-of-pocket expenses on a medical claim. Your out-of-pocket costs will vary based on the benefits provided by each plan.
Report any other health benefits/plans you have
We need to know if you have other insurance to make sure:
- We are processing claims in the correct order
- The combined payments from all plans do not add up to more than the covered health care expenses
- There is no double payment of claims
How to report other benefits
Tell your employer if you or any of your dependents are covered by more than one group health plan and give them any paperwork that may help determine which health plan is primary.
OR
Contact Priority Health at the number on the back of your membership ID card if you or any of your dependents are covered by more than one group health plan.
Send us any paperwork that may help us decide which health plan is primary, including court orders or other papers. (NOTE: Some information, like a divorce decree or court order) can't be accepted over the phone.
Learn more by reviewing your plan documents in your member account.