Coordination of Benefits

Some members have more than one health care coverage for themselves, spouse and dependents. This may include coverage from a spouse's employer, an additional individual policy, Medicare or other insurance plans. One plan becomes your primary plan. It pays your claims first. Then the second plan may pay toward the remaining costs, depending on the plan. This process is called coordination of benefits (COB).

COB provisions allow health plans to work together to help reduce your out-of-pocket expenses for medical, dental and pharmacy claims.

Every policyholder MUST complete the COB form.

To allow us to coordinate benefits, we need information about other insurance plans that you, your spouse or your dependents may have. Please login to your online member account and fill out the COB form.

You can also download the COB form here:

Not completing the COB form can result in claim payments being delayed or denied.

Frequently Asked Questions

Q: Why do members need to complete the COB form?

A: Many members have other health and dental care coverage in addition to their Blue Cross Blue Shield of Nebraska (BCBSNE) coverage. In order to accurately process your claims, we must have information on any additional coverage you or your dependents may have besides your Blue Cross and Blue Shield of Nebraska policy. For example, many members have coverage through a working spouse or a second employer, or special situations may exist for dependent children who have different health care coverage because of their parents' divorce or separation.

Q: Why does BCBSNE need this information?

A: Up-to-date information helps us process your claims faster, and it can reduce your out of pocket costs. When you have more than one health and dental benefit plan, we coordinate with your other health care carrier to ensure that claims are paid accurately.

Q: I only have Medical coverage with BCBSNE and Dental with another carrier, why do you need to know about my dental coverage?

A: We are asking if you have any additional coverage to what you have with BCBSNE. If you do not have additional medical coverage, then you would indicate on the form that you have no other insurance. Same applies to dental, we are only looking for additional coverage you have to the coverage you have with BCBSNE.

Q: Are members required to provide this information?

A: Yes. We need to know only about other coverage that is in effect while you are covered by BCBSNE. We may withhold payment on claims, pending confirmation of your other coverage information.

If you don't have other coverage, please indicate that on the form and return it to us.

Q: I am covered by two Blue Cross plans. Do I need to complete this form?

A: Yes. If you are covered by a second Blue Cross benefit plan, you must provide this information.

Q: I am no longer covered by BCBSNE. Do I still have to respond?

A: Yes, if your BCBSNE coverage was in effect at any time during the past 18 months. We need to know about other coverage that was in effect while you were covered by BCBSNE. We don't need to know about any coverage that started after your BCBSNE coverage ended.

Q: I am single, and I have no children. Why are you asking about my spouse and children?

A: This questionnaire is used for all BCBSNE members, regardless of whether they are single or married, or whether they have children. You need to answer only the relevant questions.

Q: I have other insurance but I choose not to use it. Do you still need the information?

A: Yes. We need to know about all other coverage that you or any of your covered dependents may have.

Q: I have additional questions. Where do I get answers?

A: For questions about your coverage, call the number on the back of your member ID card.

Q: Where can I fax the COB form or additional documents?

A: Fax the completed form and any documents to: 402-392-4126.

Q: Where can I mail back the COB form?

A: Please mail to:

Blue Cross Blue Shield of Nebraska

PO BOX 3248

Omaha, NE 68180

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.