Coordination of Benefits

Coordination of Benefits (COB) is a process used when you or your enrolled dependents have more than one health insurance plan. It helps you maximize your benefits by combining the coverage from both plans. 

After benefits are paid by the primary plan, the secondary plan pays its share of the remaining balance for eligible expenses, subject to the plan's benefits and limitations. To receive coverage under the secondary plan, you must follow also the rules of the primary plan.

Example: Lisa (she/her) works for Microsoft and her husband, Joe (he/his), is covered as a dependent on her plan. Joe's coverage through his employer is his primary plan. Joe's primary plan requires that he obtain a referral before accessing specialty care or the plan pays nothing. If Joe doesn't seek a referral, neither his primary plan nor the Microsoft plan will pay for the charge. He cannot bypass this referral requirement and submit a charge to the Microsoft plan as the secondary payer, even if the Microsoft plan does not have the same requirement for obtaining a referral.

Maximizing coverage

Payments made by the primary plan will count toward the Microsoft plan's deductible and coinsurance limits, if applicable.

Example: Milo (they/them) works for Microsoft and their domestic partner, Bo (he/his), is covered as a dependent under Milo's plan. Bo's coverage through his own employer is his primary plan. Bo has a procedure that is billed at $1,000. Bo's primary plan has an allowed amount of $900 for this service and pays the provider. The Microsoft plan has an allowed amount of $700, which is applied to Milo's deductible in the Microsoft plan because they have not met their deductible yet on the Microsoft plan.

Quick tip! To ensure claims are applied to your deductible and/or coinsurance maximum (if applicable), submit your claim within 12 months even if no additional payment will be made.

One of your health plans will be designated as the primary plan, and it will pay benefits first. The other plan will be the secondary plan, and it will pay the remaining eligible expenses, subject to its own benefits and limitations. See the Summary Plan Description or the for details.

Examples of when COB applies include:

You are covered under a Microsoft health plan and your spouse/domestic partner's health plan with another company. For you, the Microsoft plan is primary.
Your spouse/domestic partner is covered under a health plan with another company and a Microsoft health plan.
Your children are covered under both parents' plans (e.g., a Microsoft health plan and another company's health plan).

Spouses/domestic partners

For spouses/domestic partners who are eligible for health care coverage through another company, you can:

Have your spouse/domestic partner enroll in their employer's health plan and use Microsoft coverage as the secondary plan at no charge.
Have your spouse/domestic partner waive the coverage available through their employer and enroll as a dependent on your Microsoft plan; in this case, you will pay $75 per pay period to use the Microsoft plan as your spouse's/domestic partner's primary coverage.

If both you and your spouse/domestic partner are employed by Microsoft and are eligible for Microsoft benefits coverage, you can either enroll as a dependent under your spouse/domestic partner's plan or enroll in your own separate coverage, but not both.

Children coverage

If you choose to cover your child on your Microsoft health plan and your spouse/domestic partner's health plan with another company, your child's primary coverage will be based on the "birthday rule." This means that the insurance of the parent whose birthday occurs first in the calendar year will become primary coverage for the child. If you are separated or divorced, see the Summary Plan Description for details on COB.

When obtaining care, your dependents with secondary coverage under the Microsoft plan will need to:

Present their employer's plan ID card as primary insurance.
If the provider bills secondary insurance, present the Microsoft plan ID card as well.
If the provider does not bill secondary insurance, submit the following documents to your plan administrator:
- An Explanation of Benefits (EOB) statement from the primary plan. 
- For medical services, an itemized bill from the provider, noting the remaining costs after payment from the primary plan.
- For prescriptions, a copy of the pharmacy receipt that includes the drug name, National Drug Code (NDC) number, and amount paid.