COB Playbook

Employer Group Health Plan (EGHP), Group Health Plan (GHP), Large Group Health Plan (LGHP) An insurance policy that is provided by an employer to an active or retired employee. This type of plan is not available to the general public for purchase. The premiums are typically paid by the employer and employee. COB may apply if patient has Medicare and an EGHP.

Medigap Policies

An insurance policy that is issued to a Medicare beneficiary, specifically as secondary to Medicare . It is issued to Medicare beneficiaries with the understanding that depending on the plan selected, it only pays the percentage that is not paid by Medicare. This is true! Medigap policies are considered to be part of the patient’s Medicare coverage, therefore an EGHP would always follow Medicare/Medigap, if Medicare is primary.

Example:

Medicare Medigap

1.

2.

EGHP

3.

Supplemental Policy An insurance policy that is secondary to Medicare. It could be an EGHP that has met the COB period or a Medigap policy. It is important to find out which when discussing coverage with an insurance company.