- Health Benefits Videos
- Attend a Health Benefits Seminar
- Forms and Downloads
- Responsibilities & Health Benefits Assistance
- Choosing a Health Plan
- Changes in Status
- Flexible Spending Accounts Programs
- Effective Dates of Coverage
- Health Plan Premiums
- Transfer to Another City Agency
- Change Union/Welfare Fund
- Termination and Reinstatement
- Leave of Absence Coverage
- Special Continuation of Coverage
- Disability Benefits
- Medicare-Eligible Employees
Coordination of Benefits (COB)
NYC Health Benefits Program
You may be covered by two or more group health benefit plans that may provide similar benefits. If you have coverage through more than one plan, your City health plan will coordinate benefit payments with the other plan. One plan will pay its full benefit as a primary insurer, and the other plan will pay secondary benefits. This prevents duplicate payments and overpayments. The plan covering you as an employee is primary before a plan covering you as dependent. In no event shall payments exceed 100% of a charge.
Special Rules for Dependents of Separated or Divorced Parents
If two or more plans cover a dependent child of divorced or separated parents, benefits are to be determined in the following order:
- The plan of the parent who has custody of the child is primary.
- If the parent with custody of a dependent child remarries, that parent’s plan is primary. The step-parent’s plan is secondary and the plan covering the parent without custody is third.
- If the specific decree of the court states one parent is responsible for the health care of the child, the benefits of that parent’s plan are determined first. You must provide the appropriate plan with a copy of the portion of the court order showing responsibility for health care expenses of the child.
11 CRR-NY 52.23 NY-CRR
Member Online Portal
Log in, register for an account, pay your bill, print ID cards, and more.
Provider Access Online
Log into your account, view patient information, and more.
Login to your account, make a payment, see benefits and more.
Manage your plan.
- Renew Your Coverage
- Member Resources
- Understand Your Benefits
- Managing Your Medical Records
- Member Portal
Helpful Tools
- Make A Payment
- COVID-19 FAQs
- Health Resources
- Find a Doctor
- Member Portal Resources
- Get Coverage
Wellcare By Fidelis Care
- Medicare Resources
- Prescription Drug Information
- Fidelis Medicare Joins Wellcare
- Rights, Appeals, and Disputes
Login to your account, download forms, view auth grids and more.
Provider resources.
- COVID-19 Updates
- Authorization Grids
- Provider Bulletins
- Pharmacy Services
- Manuals, Forms and Policies
About Our Plans
- Forms for Members
- Educational Materials
- Join Our Provider Network
- Provider Portal
- Contact Provider Relations
- Provider Access Online Resources
Electronic Transactions
- Authorization Requests
See plan benefits, coverage areas, get a quote and more.
- Medicaid Managed Care
- Essential Plan
- Child Health Plus
- Qualified Health Plans
- HealthierLife (HARP)
- Medicaid Advantage Plus
- Fidelis Care at Home (MLTC)
- Over-the-Counter Benefits
- Mail Order Pharmacy Program
- Medication Therapy Management
- Qualifying Life Events
- Health Insurance Terms Explained
- About Medicare
- Medicare and Dual Advantage
- D-SNP Benefits
- Help Me Find a Plan
- Online Medicare Application
Welcome, Providers!
Latest news.
The Coordination of Benefits Agreement (COBA) program establishes a uniform national contract between CMS, benefit programs and other health insurers. COBA is a standard processing methodology used by the national Medicare community. COBA allows greater efficiency and simplification via consolidation of the claims crossover process.
Under COBA, Medicaid providers will submit claims for Medicare/Medicaid eligible beneficiaries to the Medicare fee-for-service claims system for processing. Medicare will:
- Process the claim
- Apply any deductible/coinsurance or co-pay amount
- Forward the claim to Fidelis Care for further claims processing.
For claim types included in the COBA agreement, providers will no longer need to bill Medicaid separately for the Medicare deductible, coinsurance or co-pay amounts. Please note, it is crucial that providers provide the appropriate NPI number and TIN on the claim form in order to ensure seamless processing by Fidelis Care.
If you have any questions, please contact your Fidelis Care Provider Relations Specialist, or connect with our Call Center at 1-888-FIDELIS (1-888-343-3547).
Verify member eligibility or renewal status, check claims, send e-scripts, and more.
Member Renewal Information
Health insurance will no longer be automatically renewed for Medicaid Managed Care, Essential Plan, Child Health Plus, or HealthierLife members.
Join Our Network
Apply to our network and become a part of the Fidelis Care mission.
Required Cultural Competency Training
Access the Provider Attestation Statement and submit completion of training.
Authorization Resources
To submit prior authorization request types, use the Fidelis Care provider portal.
Submit claims electronically for faster processing and reimbursement.
Utilization Management (UM)
Find information and links to external vendor authorizations and to internal resources.
Join Our Team
Information for..., insurance help.
- Shop for a Plan
Fidelis Care Tools
- Make a Payment
- Transparency in Coverage Machine Readable Files
Fidelis Care Community
- By clicking on these links, you will leave the Fidelis Care website.
IMAGES
VIDEO
COMMENTS
Laws Ins. Law Art. 32. Ins. Contracts - Life, Accident & Health, Annuities § 3224-C Insurance Law Section 3224-C Coordination of benefits
The Coordination of Benefits Agreement (COBA) program establishes a uniform national contract between CMS, benefit programs and other health insurers. COBA is a standard processing methodology used by the national Medicare community. COBA allows greater efficiency and simplification via consolidation of the claims crossover process.
NYC Health Benefits Program Coordination of Benefits (COB) You may be covered by two or more group health benefit plans that may provide similar benefits. If you have coverage through more than one plan, your City health plan will coordinate benefit payments with the other plan.
Reminder to Providers: New York State Medicaid Requires Coordination of Benefits Addition to the Medicaid Dental Program D1354 - Interim Caries Arresting Medicament Medicaid Fee-for Service Coverage Policy and Billing Guidance for Vaccinations Pharmacy Update Matching Origin Codes to Correct Prescription Serial Number in Medicaid Fee-for-Service
(b) A coordination of benefits (COB) provision is one that is intended to avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment.
The Coordination of Benefits Agreement (COBA) program establishes a uniform national contract between CMS, benefit programs and other health insurers. COBA is a standard processing methodology used by the national Medicare community. COBA allows greater efficiency and simplification via consolidation of the claims crossover process.