Coordination of Coverage
Coordination of Benefits In Cases of Double Coverage
If you or a dependent are also covered under another non-GVSU group medical plan, one of the plans is deemed "primary," and the other, "secondary." The primary plan pays benefits first and the secondary plan provides payment after that. A plan is always primary if it covers you as the employee. If a dependent is covered under two plans, the plan of the parent whose birthday is earlier in the calendar year will be primary. Under "traditional" coordination of benefits, the secondary plan generally pays whatever the primary plan does not. The GVSU Standard PPO Plan follows traditional coordination of benefits rules.
GVSU's Standard PPO Plan follows a "non-duplicating" method for the coordination of benefits, which applies whenever the Standard PPO Plan is the secondary plan for a claim. In such cases, the Standard PPO Plan will pay only the difference between what the primary plan pays and the amount the Standard PPO Plan would have paid if it had been the primary plan.
Coordination of Automobile Coverage
The GVSU Standard PPO and GVSU High Deductible PPO Plans do not provide any coordination benefit with your automobile insurance. The Plans do not pay for illness or injuries received in an automobile accident in Michigan or any other state with no-fault insurance.
Michigan No-Fault Automobile Insurance
Based on the Michigan No-Fault insurance statute all carriers provide coverage for medical claims associated with an accident. The total cost of the auto insurance coverage is impacted by whether the driver has coordinated coverage with their employers’ health plan. The financial impact varies by the carrier, the number, age and driving history of the drivers covered.
If you are enrolled in the GVSU Standard PPO or GVSU High Deductible PPO Plans you should make a call to your auto insurance carrier and let them know that your coverage in the GVSU plans exclude automobile illness and injury received as a result of an automobile accident.
Special Rule for Motorcycles
The GVSU Standard PPO and High deductible PPO Plans would provide coverage in the event of a motorcycle accident and pay the associated claims. Concurrent with paying the claims the plans would pursue reimbursement through the motorcycle insurance provider to the extent of the coverage available.
The law starts with your first auto insurance renewal on or after July 1, 2020.
The GVSU health plans will continue to exclude coverage for claims related to an automobile accident because:
- Personal injury protection (PIP) benefits generally cover substantially more items and services than the GVSU health plans would
- Making modifications to your home to accommodate wheel chair or other requirements
- Having a home health aide
- Extending long-term nursing care
- PIP benefits last for life (if unlimited) or until the PIP benefit maximum is reached. Coverage under your GVSU health plans will cease when an individual ceases to be eligible (e.g., inability to return to work), with possible extensions (employer-provided FMLA -generally 12 weeks, and/or COBRA- generally 18,29, or 26 months)
- Because GV medical plans exclude auto accident claims it is not considered a "Qualified Medical Plan"
When renewing your auto insurance coverage on or after July 1, 2020, you will have several PIP coverage options to choose from. You will want to carefully review those options with your auto insurance provider. Be sure and tell them that the Grand Valley medical plans exclude coverage for claims related to auto accidents.
For more information you can contact your auto insurance provider or the Michigan Department of Insurance and Financial Services.