Coverage Under More Than One Plan (Coordination of Benefits)

Coordination of Benefits rules are set by the National Association of Insurance Commissioners (NAIC) with the exception of coordination with Medicare and Medicaid which are set by federal and state law. The LM HealthWorks Plan follows these standard NAIC rules to ensure ease of coordination with other plans.

Here’s how it works:

If you are covered under both the LM HealthWorks plan and another health care plan:

When you are the subscriber of the plan, that plan is your primary insurer. For example, a husband and wife who both subscribe to different plans, will be covered first by the plan in which each subscribes.
When both parents have health care plans that cover children or other dependents, the benefits of the plan of the parent whose birth date falls earlier in the year will be used first for the dependent child. (Example: If a child’s mother’s birth date is in February and the same child’s father’s birth date is in September, the child is covered under the mother’s plan first.)
The benefits available under the LM HealthWorks Plan may be coordinated with other benefits available to you under any auto insurance, workers’ compensation, Medicare or other coverage.

To expedite the payment of medical bills and help prevent receiving bills yourself, remember to provide your doctor with health benefits information for all plans that cover you or your family members. For more details regarding Coordination of Benefits, refer to your Summary Plan Description (SPD) after the plan effective date (January 1).

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