Coordination of Benefits Clause
A contractual provision in a dental benefits agreement specifying how payment is allocated when a patient holds coverage under more than one dental plan.
Full Definition
The coordination of benefits (COB) clause establishes the hierarchy and calculation method used when a patient is covered by two or more dental insurance policies, designating a primary and secondary carrier. It prevents duplicate payment and dictates how residual amounts may be claimed from the secondary insurer. Editors reviewing insurance policy documents and claim correspondence must ensure that references to the primary and secondary payer are consistently and correctly identified throughout the text. Misidentification of the payer order in documentation can lead to claim denials or compliance issues.
Usage
Usage note: Distinguish from the broader term 'Coordination of Benefits (COB)', which refers to the process; the 'clause' refers specifically to the written contractual provision. Editors should verify that 'primary' and 'secondary' payer designations are unambiguous.
In Context
- "The policy document's coordination of benefits clause required careful editing to ensure the primary-payer language appeared consistently in every section." — Insurance policy document
- "A misplaced modifier in the coordination of benefits clause led to ambiguity about which plan bore first responsibility." — Legal review of benefits contract