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Coordination of Benefits

Coordination of Benefits Questionnaire

If you have other insurance, please complete the Coordination of Benefits Questionnaire adobe pdf

Send the completed form to FirstCarolinaCare as soon as possible.

Order of Payment

If a Member is enrolled in another group health plan, FCC may coordinate benefits with the other plan so that benefits paid by both plans do not exceed the maximum allowable for the Covered Service. When benefits are coordinated, one plan pays first ("primary plan") and the other plan's ("secondary plan") benefits may be reduced accordingly. The State of North Carolina has established uniform rules for determining how benefits are coordinated. The rules regarding order of payment are briefly described as follows:

  • The plan covering a person as an employee is primary.
  • The plan covering a person as a spouse is secondary.
  • The plan covering a child as a dependent of the parent whose birth date falls first during the year is primary.
  • If both parents have the same birth date, the plan that has covered a parent for the longer period of time will be primary.
  • If the parents are divorced or separated, the plan that covers the child as a dependent of the parent with custody is primary.
    • The plan that covers the child as a dependent of the spouse of the parent with custody is primary to the plan that covers the child as a dependent of the parent without custody.
  • If there is a court order that requires a parent to purchase the child's health coverage and FCC has knowledge of the court order, then that plan will be primary.
  • A plan that covers a person other than as a laid-off or retired employee or as a dependent of other than a laid-off or retired employee is primary to a plan that covers the person as a laid-off or retired employee (unless this results in a conflict in determining order of benefits).
  • If none of the above rules apply, the plan that has covered a person the longest is primary.
  • If the other plan does not have rules that establish the same order of benefits as FCC, then that plan will be primary.

For additional information, please refer to your Certificate of Coverage available in the Resources section of the site.