Rules that determine which health insurance plan pays first when you are covered under two or more plans. The primary plan pays its share of covered expenses first, and the secondary plan may cover some or all remaining costs. Coordination prevents paying more than 100% of the total bill.
Related Terms
Coinsurance
The percentage of costs you share with your insurer after meeting your deductible. For example, with 80/20 coinsurance, the insurer pays 80% of covered expenses and you pay 20% until you reach your out-of-pocket maximum.
Explanation of Benefits
A statement sent by your health insurer after a claim is processed that shows what was billed, what the plan covered, what discount was applied, and what you owe. An EOB is not a bill, but it helps you understand how your benefits were applied to a specific service.
Out-of-Pocket Maximum
The most you have to pay for covered health care services in a plan year. After you reach this amount through deductibles, copays, and coinsurance, your plan pays 100% of covered services for the rest of the year. This cap protects you from catastrophic medical bills.