Coordination of Benefits – HMSA and Another Carrier

Determining Primacy

The following guidelines apply when a member has more than one group health benefit plan:

• The plan that covers the member as the subscriber or policyholder pays first.
• If a child is covered under both the mother’s and father’s plan, the plan of the parent whose birthday is earlier in the calendar year pays first. (If both parents have the same birthday, the plan with the earlier effective date pays first.)
• In situations where an individual is the subscriber to one policy as an active worker and another policy as an inactive or retired worker, the plan that covers the individual as an active worker is the primary plan.

When none of the general coordination of benefits rules listed above applies, the coverage with the earliest continuous effective date pays first.

Note: Coverage of dependent children of divorced or separated parents is determined according to special rules. Please contact an HMSA Provider Services Representative if you have questions about these coverage rules.

Claims Filing

If HMSA is the secondary payer, the pharmacy should file the claim with the primary payer first and supply the member with a completed UCF Long Form (UCF Instructions – Long Form) for the member to submit to HMSA.

Revision History