Prescription Plan COB

[Guest Jean Marie]

My spouse and I are both employed. His health plan is secondary to mine, and his pays secondary (coordinates) benefits with my medical plan. They will not, however, pay secondary on prescription coverage. Is this legal, as they do not have it stated in their spd that they will not pay secondary on prescriptions? One other note, I asked their benefits manager about this issue and she responded that "it is not in writing, but we don't pay secondary on prescriptions". I am thinking about filing an ERISA claim, but don't know if it is worth it....espicially since my spouse still works there. My ERISA claim would be that they have to provide employees with written details of the plan, etc. I received an SPD, but it indicates that prescriptions are covered, and I was issued a prescription card. Any advice from anyone?

[Larry M]

[i am not an attorney]

It is my understanding that a plan will generally recognize under COB, and pay for, only those benefits which are covered by the plan itself.

So, for example, if your husband's plan does not cover prescriptions and your plan does, his plan does not have to pickup the excess over what your plan pays.

On the other hand, if there are other medical expenses involved and there are unpaid expenses after your plan has paid its portion, then your husband's plan should pay the excess - but no more than what it would have paid w/o COB.