Coordination of Benefits

Note: PacifiCare changed its name to UHC of California and will do business as (dba) UnitedHealthcare of California, effective May 2011. (See the March 25, 2011 announcement.)

Initially, members provide Coordination of Benefits (COB) information on the enrollment form.  The information is entered into our membership database.  If the member did not provide complete COB information, the system still flags COB candidates (for example, dependent spouse who may be working and covered by another carrier; dependent children may be covered by the plan of the parent with birthday earlier in the year).  We derive additional COB information from submitted claims.  We also monitor information from HMO providers and outside medical claims for COB activity.

Our authorization process ensures that COB data is constantly validated and updated.  Inquiries from other carriers and follow-up COB questionnaires assist us in keeping current information on all COB members.

We follow the National Association of Insurance Commissioners' guidelines and California law in coordinating benefits.