There may be a client exception to how you would handle your patient’s COB. Before providing services to your patient, please obtain a Patient Record Report from eClaim on eyefinity.com. The Patient Record Report will highlight the rules from the following list that may apply to your patient’s coverage and ability to coordinate benefits. Call VSP at 800.615.1883 if you have questions.

• COB rule 1: If both members are covered by the same client, COB isn’t allowed for either of the members or their children. If the member is covered twice by the same client, COB isn’t allowed.
• COB rule 2: If both members are covered by the same client, children are covered only under one parent's plan. COB can’t be applied and the child may only receive one set of services. This applies both to biological parents and step-parents.
• COB rule 3: If both members are covered by the same client, the secondary plan can be used to cover copays only, which will use all service areas.
• COB rule 4: This rule applies only when the patient has an insurance carrier other than VSP as primary. If both plans are through VSP, this rule doesn’t apply. However, other COB rules may still apply. COB reimbursement is calculated by subtracting what the primary carrier paid from what VSP would have paid as primary.

• COB rule 5: A married couple, or domestic partners, who are covered by the same client may coordinate benefits, but can’t receive two sets of services.
• COB rule 6: COB isn’t allowed for Computer Vision Care (CVC), Repair, Safety Eyecare, or ProTec Safety benefit types.
• COB rule 7: A married couple, or domestic partners, who work for the same client may either use both of their benefit plans separately to receive two sets of services, OR COB their secondary benefits to pick up only the primary copays (using all services).
• COB rule 8: If a member’s dependents have vision coverage through their own employment, coverage through that employment is primary. If dependents have coverage under Medicaid State Children’s Healthy Insurance Program (SCHIP), there’s no COB.
• COB rule 9: COB isn’t allowed. Call VSP at 800.615.1883 for client exceptions and specific instructions.
• COB rule 10: A child covered under both parents’ plans will always use the father’s plan as primary.
• COB rule 11: Employees and dependents can use their second-pair coverage towards overages from their first-pair coverage.
• COB rule 12: If both members are covered by the same client, COB is allowed to cover out-of-pocket expenses only, but the patient can’t receive two sets of services.