COB Playbook

COB Rules for Multiple Commercial Carriers

EGHP vs. Individual

Subscriber Rule

Effective Date Rule If covered by two EGHPs, the policy with the earliest effective date is primary

Per CMS, EGHP plans are always primary over Individual Plans (non-Medigap coverage)

The policy holder’s policy is primary over another policy where they are a covered dependent

A person covered by two EGHPs, one through active employment and one as a retiree– the policy through active employment is primary, regardless of who owns the policy Retiree Rule

Birthday Rule

Gender Rule If a dependent is covered by more

If a dependent is covered by more

than one EGHP with different subscribers, the primary policy will be based off of whoever’s birth date (MM/DD) occurs first

than one EGHP with different subscribers and the Birthday rule is not followed, when possible, the male subscriber’s policy is primary over the female subscriber’s policy

Divorce/Legal Separation Rule

If a dependent (child) is covered by an EGHP from each parent who is divorced or legally separated (or never married), the primary policy is determined by

The court

o

o If the court does not determine the primary policy, it is determined by the custody agreement  Legal custodial parent’s policy is primary  Joint custody follows the Birthday rule to determine the primary policy