Small Group Blues Enroll - Arkansas Blue Cross and Blue Shield

ARKANSAS BLUE CROSS AND BLUE SHIELDSMALL GROUP BLUESENROLL GROUP ADMINISTRATOR’S MANUALSection 7 - COORDINATION OF BENEFITS (COB)COB SAVINGSCOB Savings is the difference charged to the utilization of the group based onArkansas Blue Cross and Blue Shield’s status as the primary payer versus thesecondary payer.For example, if one of the employees had a $1,000 claim, and Arkansas BlueCross is the primary payer, we would pay 80% or $800 (assuming the co-pay is80% and the deductible has been met and the charge is less than the maximumallowance set by Arkansas Blue Cross).EXAMPLE 1: Arkansas Blue Cross as thePrimary PayerArkansas Blue Cross would pay80%$1,000 x 80% = $800If Arkansas Blue Cross is the secondary payer, we will pay contract benefits(80%), or the balance of the bill, whichever is less. In the above example, $800would be the 80% contract benefit; however, the balance of the bill, $200, wouldbe paid because it is the lesser amount.EXAMPLE 2: Arkansas Blue Cross as theSecondary PayerThe other insurance company would pay 80% 5$1,000 x 80% = $800Arkansas Blue Cross pays thedifference$1,000 - $800 = $200Charge $1,000 Our allowance $800Other paid $ 800 Secondary pay $200Balance $ 2005 Other insurance companies may or may not pay 80%Small Group BluesEnroll R 10/25/07 23