When an employee is covered by Sharp Health Plan and another health plan, there is a coordination of benefits between the two plans.
The goal of this kind of coordination is to maximize coverage for allowable expenses, minimize out-of-pocket costs, and prevent any payment duplication. Total payment from all coverage should never exceed 100% of the allowable expenses. Details can be
found in our Group Administration Manual.
Then the "birthday rule" applies. The child’s primary coverage is the plan of the parent whose birthday (month and day) comes first in the year. If both parents have the same month and day of birth, then the coverage that has been in place longer is the primary.
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