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Public Entity Members

Coordination of Benefits

Benefits payable by MCHCP medical plans are subject to coordination of benefits. This prevents overlapping payments for the same service and claim delays. If members are covered under more than one benefit plan, the health plan must be notified.

Under coordination of benefits, one plan is designated as primary and the other is designated as secondary. Claims will be paid by the primary plan first according to its benefits. If applicable, any charges remaining may be paid by the secondary plan.

When MCHCP is secondary, MCHCP benefit payments will not exceed what it would have paid if it were primary. If the primary carrier's payment is more than MCHCP would have paid as primary, MCHCP's payment as secondary payer is zero.

State rules determine which plan is primary. For more information, refer to the Code of State Regulations (22 CSR 10-3.070 Coordination of Benefits).

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