Which statement about Coordination of Benefits is false?

• A. It applies when more than one group health policy covers the same loss
• B. It coordinates benefits to prevent duplicate payments
• C. It requires the primary policy to pay first
• D. It has no impact on multiple policy scenarios

Answer: (D)

Coordination of Benefits is the process used when more than one group health plan covers the same loss to determine how payments are made and to prevent paying more than the actual charges. The statement that it has no impact on multiple policy scenarios is false because COB is specifically designed for those situations, ensuring orderly payment when several policies apply.

This concept applies whenever multiple policies cover the same loss, and its purpose is to coordinate payments so no duplicate payments occur. It also establishes the payment order: the primary policy pays first, up to its limits, and the secondary policy can pay the remaining allowable charges up to its own limits, subject to the plan’s rules. An example helps: if a medical bill is $1,000 and the primary plan covers up to $800, the primary pays $800; the secondary then may cover the remaining $200 if its limits and coordination rules allow.

So the false statement is the one claiming there’s no impact on multi-policy scenarios; in reality, COB is specifically about managing payments across multiple policies.