What is required for primary plans under Coordination of Benefits rules?

For primary plans under Coordination of Benefits (COB) rules, they are required to pay benefits as if secondary plans do not exist. This means that when a primary plan is determining its payment obligations, it does so without considering any other insurance that may also cover the same expenses. The primary plan focuses on its own policy limits, terms, and conditions, ensuring that the insured receives the maximum benefits available under that policy alone before any other coverage is taken into account.

In a COB situation, the primary plan will pay benefits according to its coverage provisions and will not be influenced by the presence of any secondary plans. This is critical to ensure that the insured does not end up with decreased benefits simply because they have multiple sources of coverage. Therefore, the primary plan functions independently of any secondary coverage, providing a necessary and distinct layer of financial protection.

Other options suggest incorrect interpretations of COB rules. For instance, unconditional coverage of all costs or limiting coverage to dependent children does not reflect the standard practices in health insurance coordination. Similarly, the notion that a plan can refuse benefits for any reason would contradict the obligation to provide benefits as outlined in the policy and applicable laws. The focus in COB is on ensuring proper benefit coordination rather than denying coverage based on other existing