Coordination of Benefits

Q. How do I know if my or my spouse’s insurance is primary?

A. If you are the employee, your GatorCare coverage is primary for you. Your spouse’s policy is primary for him/her and secondary for you provided you also are covered by your spouse’s policy. If you have children covered on both plans, except in the case of separation or divorce, the plan of the parent whose birthday excluding year of birth, falls earlier in the year, is the primary coverage. For more information on how your other coverage coordinates benefits, please contact that plan provider.

 

Q. How will GatorCare coordinate with my other health insurance?

A. GatorCare follows a standard Coordination of Benefits (COB) process. It is the member’s responsibility to inform Florida Blue of any duplication of benefits or other health plan coverage. When GatorCare is your primary health plan, covered services are reimbursed without regard to coverage under the other plan. When GatorCare is not your primary health plan, covered services are reimbursed based on what the other insurance did not pay only up to the Florida Blue primary liability. In the event the primary payer’s insurance exceeds the allowed amount, no payment will be made for such services.