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COB Rules for Multiple Commercial Carriers
Per CMS, EGHP
plans are always
primary over
Individual Plans
(non-Medigap
coverage)
EGHP
vs. Individual
Subscriber Rule
Effective Date Rule
If covered by two
EGHPs, the policy
with the earliest
effective date is
primary
If a dependent is
covered by more
than one EGHP with
different subscribers,
the primary policy
will be based off of
whoever’s birth date
(MM/DD) occurs first
A person covered by
two EGHPs, one
through active
employment and
one as a retiree– the
policy through
active employment
is primary,
regardless of who
owns the policy
Retiree Rule
Birthday Rule
Gender Rule
If a dependent is
covered by more
than one EGHP with
different subscribers
and the Birthday rule
is not followed, when
possible, the male
subscriber’s policy is
primary over the
female subscriber’s
policy
If a dependent (child) is covered by an EGHP from each
parent who is divorced or legally separated (or never
married), the primary policy is determined by
o
The court
o
If the court does not determine the primary
policy, it is determined by the custody agreement
Legal custodial parent’s policy is primary
Joint custody follows the Birthday rule to
determine the primary policy
Divorce/Legal Separation Rule
The policy holder’s
policy is primary
over another policy
where they are a
covered dependent