Health Insurance Coordination of Benefits

How Coordination of Benefits Saves Money for Your Employees

ClaimLinx saves business owners as much as 20 to 40 percent on employer-paid health insurance. We also strive to find the best possible health insurance plans for your employees and their families through our ClaimLinx Solution. ClaimLinx discusses how the coordination of benefits saves money for your employees.

What Is Coordination of Benefits?

Coordination of benefits defines how two insurance plans work together to cover an employee’s payments for his or her health insurance claims. In general, a person’s primary health insurance plan comes from a major medical carrier, such as Anthem, Aetna, Humana, etc. This coverage goes into effect first, when an employee files a claim. Secondary coverage, a health insurance plan that goes into effect second, might pay for some or all of the remaining medical expenses. With the ClaimLinx Solution, secondary coverage comes from a Medical Expense Reimbursement Plan (MERP) for medical expenses and/or an independent Pharmacy Benefit Manager for prescriptions. The extra coverage done this way is easy to customize to fit an employer’s budget and employees’ needs.

How Does Coordination of Benefits Work?

Providers, pharmacies or employees file a health insurance claim with their primary health insurance plan. This plan takes care of the person’s expenses based on the plan’s deductibles and copayments (co-pays). Any out-of-pocket expenses leftover from the first plan might be paid by the secondary coverage. 

Why Use a Coordination of Benefits?

Using a coordination of benefits is a key part of the ClaimLinx Solution. The main goal of organizing a health insurance plan this way is to spread out costs and risk. Using a self-funded MERP can be expensive for employers. That’s why combining it with a primary plan with a major carrier works. Now, the company is able to offload some of the cost by having insurance companies pay for part of the bill.

How Coordination of Benefits Saves Employees Money

Having two health insurance plans may seem complicated for employees. After all, things seem simpler when an employee only has one company to go to for coverage. However, there are advantages to having two plans (and a coordination of benefits) if it allows employers to maintain or even improve benefits.

Many times, ClaimLinx consultants have seen businesses cut benefits to keep the cost of an insurance plan down. That means employees have to pay more for healthcare. Using a coordination of benefits makes providing a plan cheaper so employers can keep offering good benefits.

For example, an employee has a visit with a specialist that costs $150. The primary plan covers 40 percent of the cost, or $60. In the past, this may be all the employer could afford. But with the ClaimLinx Solution providing savings, a secondary plan has been added. The secondary coverage, or self-funded plan provided by the employer, now covers the visit for an additional $60. Now, the employee only pays $30 for the visit.

ClaimLinx Helps with Coordination of Benefits

ClaimLinx is a full-service insurance agency and a third-party administrator for health insurance plans. We provide insurance plans for your employees that could save as much as 40 percent on your employer-paid benefits. We also determine the best plans for workers with respect to coordination of benefits. Contact our office today or call us at 1-800-858-1772 for more information.

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