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Coordination Of Benefits

Definition

Coordination Of Benefits (COB): When a person is covered by more than one health or dental plan—most commonly through two working spouses or through both an employer plan and a retiree or student plan—Coordination Of Benefits is the set of rules that decides which plan pays first and how the second (or third) plan tops up or reimburses any remaining amount. The goal is to prevent over-payment (no one may profit from a claim) and to make sure the plans together pay as much as possible, up to—but not above—100% of the eligible expense. In Canada, insurers follow a standard framework (often the Canadian Life and Health Insurance Association guidelines) that assigns the order of payment: a plan where the person is the “primary subscriber” (e.g., their own employer’s plan) pays before any plan where the person is simply a “dependent” (e.g., a spouse’s plan). Children’s claims are paid first by the plan of the parent whose birthday falls earliest in the calendar year, then by the other parent.

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