Coordination of benefits

When you have coverage under two plans

If both Health Tradition and another health plan cover you or your family, these plans will coordinate benefits and share the responsibility for paying your eligible medical bills. Coverage with more than one health plan most often occurs when two spouses work for different employers and each enrolls the other and/or children in their health plan. In this case, one health insurance plan becomes primary and one becomes secondary (you will not be reimbursed for more than the cost of any health care service you receive).

If Health Tradition is primary

You will need to file your Explanation of Benefits (EOB) forms with your secondary insurance plan. An EOB is a form sent to you after a claim has been processed outlining how much money the plan paid and the amount you are personally responsible for paying.

If Health Tradition is secondary

You will need to file your primary insurance plan’s EOB forms (or Medicare Summary of Notice) with Health Tradition. It is your responsibility to provide us with complete information about your other health insurance plan(s). If we do not have complete information, we cannot process your claims correctly. Your EOB will report a denial of payment for lack of information when the other health insurance plan information is not sent along with your claim.

For members who are Medicare eligible, please contact us directly for more detailed information on filing order.

Coordination of benefits for prescriptions

Coordination of benefits does not apply to employer group plan members who have other commercial coverage (non-Medicare or Medicaid). Members must choose one of the coverage plans available to them for prescription coverage.

If you have questions about prescriptions or this process, please contact Customer Service toll-free at 877-832-1823.