Use this article to learn the difference between primary and secondary insurance, when Coordination of Benefits (COB) applies, and which insurance plan to submit to Alma.
What is Coordination of Benefits (COB)?
Coordination of Benefits (COB) is the process insurance companies use to determine which insurance plan pays first when you're covered by more than one health insurance plan.
This helps ensure your claims are processed correctly and prevents duplicate payments.
What are Primary and Secondary Insurance?
If you're covered by more than one health insurance plan:
- Primary insurance processes your claim first and pays according to your plan benefits.
- Secondary insurance may process any remaining balance after your primary insurance, depending on your coverage.
Your insurance companies determine which plan is primary and which is secondary based on Coordination of Benefits rules. E.g: You might have Aetna through your employer and UnitedHealthcare through your spouse. Aetna may be primary, and UnitedHealthcare may be secondary.
| Note: Alma does not accept secondary insurance. Only submit your primary, active insurance plan to Alma. If you submit a secondary plan instead, your insurance company will deny the claim, and you'll owe the full out of pocket cost for each session unless you provide an eligible primary plan that Alma partners with. |
Primary and secondary insurances aren't interchangeable, and Alma can't choose one for you. Your insurance companies decide which plan is primary. Alma also can't submit to your primary plan, expecting a denial, and then bill your secondary. Secondary insurers only process claims after the primary insurer has already processed them. These are insurance industry rules, not decisions Alma makes.
When does COB Apply?
COB only applies if you're covered by more than one health insurance plan.
For example, you may have:
- Insurance through your employer and your spouse's employer.
- Medicare and a commercial insurance plan.
- Two employer-sponsored health insurance plans.
If you only have one health insurance plan, COB does not apply.
How Insurers Decide Which Plan is Primary
If you're not sure which of your plans is primary, these are the standard rules insurance companies generally follow:
| Situation | Primary | Secondary |
|---|---|---|
| Under 26, covered by your own school/employer plan and a parent's plan | Your school or employer plan | Parent's plan |
| Married, each partner has coverage through their own employer | Your employer's plan | Spouse's employer plan |
| Under 26, married parents each cover you separately | Parent whose birthday is first in the calendar year (“birthday rule”) | Parent whose birthday is second |
| Under 26, divorced parents each cover you separately | Parent with custody (or birthday rule if joint custody) | Parent without custody, or birthday rule |
| Retired or covered by Medicare/Medicaid | Medicare is always primary | Any supplemental or former employer plan |
If you're still not sure, contact your insurance company directly to confirm.
What Should I Do if I Have More Than One Insurance Plan?
Make sure the insurance you submit to Alma is your primary, active plan. If your situation matches one of the rows in the table above, you may want to confirm with your insurer before submitting your information.
What if My Insurance Information Changes?
Notify your provider and update your insurance information as soon as possible.
Keeping your insurance information current can help reduce delays or unexpected changes to your session costs. To learn more, see: Update Your Insurance Information in the Alma Client Portal
If your insurance company flags a coordination of benefits issue on a claim, see Resolving a Coordination of Benefits (COB) Issue for what to do next.