Impact of dependent coverage provision on coordination of benefits
The health care reform provision that extends dependent coverage to age 26 (regardless of student status, employment status or marital status) presents a new scenario for dual coverage: A member could be a dependent child on one policy and a spouse on another.
In this situation, the same coordination of benefits rules that existed before health care reform continue to apply. The member's benefit contract language provides the plan's coordination of benefits rules. Most self-insured plans follow National Association of Insurance Commissioners (NAIC) model COB rules. For fully insured plans, the COB provisions in our certificates are based on state COB rules (which are generally based on the NAIC model rules, but the requirements and language vary slightly by state).
For more details and talking points, refer to this fact sheet.