Subrogation and Coordination of Benefits (COB) rules

Our benefit plans are subject to subrogation and coordination of benefits (COB) rules.

1. Subrogation — To the extent permitted under applicable law and the applicable benefit plan, we reserve the right to recover benefits paid for a member’s health care services when a third party causes the member’s injury or illness.

2. Coordination of Benefits (COB) — COB is administered according to the member’s benefit plan and in
accordance with applicable law. UnitedHealthcare can accept secondary claims electronically. To learn more, go to  Claims & Payments  Electronic Claims Submission (EDI ), contact your EDI vendor, or call EDI support at (800) 842-1109.

Primary Plan  --- Plan that pays benefits first  --- Benefits under the primary plan will not be reduced due to benefits payable under other plans

Secondary Plan  --- Plan will pay benefits after the primary plan  --- Benefits under the secondary plan may be reduced due to benefits payable under other primary plans

Tertiary Plan     --- Three or more group benefit plans may provide benefits for the same medical expense
Tertiary plans would offset the incurred expenses with the benefits paid by the primary and secondary carriers, and provide benefits for any remaining unreimbursed expenses

Note: When coordinating benefits with Medicare, all COB Types coordinate up to Medicare’s allowed amount when the provider accepts assignment. Medicare Secondary Payer (MSP) rules dictate when Medicare pays secondary.
3. Workers’ Compensation — In cases where an illness or injury is employment-related, workers’ compensation is primary. If notification is received that the workers’ compensation carrier has denied the claim, the provider should submit the claim to UnitedHealthcare, regardless of whether the case is being disputed. It is also helpful to send the other carrier’s denial statement with the claim.

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