NYC Health Benefits Program

Coordination of Benefits (COB)

You may be covered by two or more group health benefit plans that may provide similar benefits. If you have coverage through more than one plan, your City health plan will coordinate benefit payments with the other plan. One plan will pay its full benefit as a primary insurer, and the other plan will pay secondary benefits. This prevents duplicate payments and overpayments. The plan covering you as an employee is primary before a plan covering you as dependent. In no event shall payments exceed 100% of a charge. 

Special Rules for Dependents of Separated or Divorced Parents

If two or more plans cover a dependent child of divorced or separated parents, benefits are to be determined in the following order:

  1. The plan of the parent who has custody of the child is primary.

  2. If the parent with custody of a dependent child remarries, that parent’s plan is primary. The step-parent’s plan is secondary and the plan covering the parent without custody is third.

  3. If the specific decree of the court states one parent is responsible for the health care of the child, the benefits of that parent’s plan are determined first. You must provide the appropriate plan with a copy of the portion of the court order showing responsibility for health care expenses of the child.