Double Coverage and COB Information

1. What is Double Coverage?

Double Coverage exists when individuals covered under our Plan are also eligible for benefits under any other kind of group health or accident plan regardless of who pays the premiums, for example:

Additional information on this is available upon request and in the Plan's brochure.

2. What is COB?

COB stands for "coordination of benefits." It is a standard insurance industry system for the payment of claims when an individual is covered by two or more group health or accident policies (double coverage). When Double Coverage exists, one plan will be considered primary (Pays its benefits first) and the other plan will be secondary (see number 3). After the primary plan has paid its benefits, the secondary plan will coordinate (supplement) benefits with the primary's payment allowing a combined payment of up to, but not more than, 100% of covered charges. It is possible in certain situations that both plans would pay their regular contract allowances which, when added together, would not total 100% of covered expenses. This usually occurs when covered expenses only exceed the deductible by a small amount.

3. Who Pays First?

Recognizing the complexities of Double Coverage, the health insurance industry with the cooperation of the National Association of Insurance Commissioners (NAIC) developed a system for determining the primary payer which is called the "Order of Benefit Determination." Our contract requires the Plan to follow these guidelines.

4. How to File With NALC.

When you have Double Coverage, obtain duplicate copies of all medical bills.

Failure to follow the above filing procedures may result in delay of payment.

In order to maintain current records, the Plan must be notified of changes in your enrollment with your other coverage.

5. What is NOT Double Coverage?

If an individual is eligible for benefits through a nongroup individual policy and the premiums are paid by the policyholder direct to the insurance company, Double Coverage does not exist and the NALC Health Benefit Plan for Employees and Staff will pay its contract allowance without regard to any payments made by the other insurance company.

Benefits received under the following are not considered Double Coverage under the NALC Health Benefit Plan for Employees and Staff:

6. Additional Information

For details describing all of the benefits, refer to the NALC Health Benefit Plan for Employees and Staff Brochure. For other information and verification, contact the Plan at:

NALC Health Benefit Plan for Employees and Staff
P O Box 678
Ashburn, Virginia 20146
(703) 729-4677 / 1-888-636-6252