Annual Coordination of Benefits

  

YOUNGSTOWN STATE UNIVERSITY 

HEALTH INSURANCE COORDINATION OF BENEFITS REQUIREMENT

 

ACTION REQUIRED

 

The University's Coordination of Benefits requirement mandates that every YSU employee who has a spouse enrolled in a YSU medical plan to 
ANNUALLY complete the Coordination of Benefits form.  

 

Coordination of Benefits Forms must be submitted  NO LATER THAN 

DECEMBER 1, 2021

TO THE  benefits secure upload. 

 

An employee who does not submit a Coordination of Benefits Form for their spouse who is enrolled in coverage with a YSU medical plan will have their spouse' s status in the YSU medical plan changed to secondary coverage effective January 1, 2022.  
 

  • Primary medical coverage is insurance that pays the claims first on a claim for medical and hospital care.  

  • Secondary medical coverage is insurance provides additional coverage for dependent(s) in addition to primary medical insurance. Secondary medical insurance pays after claims are processed through the primary medical insurance coverage.  

   

Under the University's Coordination of Benefits requirement, if your spouse's employer offers group medical coverage, your spouse must enroll in their employer's group medical as their primary coverage, unless your spouse:
 
  • works less than 25 hours per week AND
  • must pay more that 50% of the monthly single premium paid by the spouse's employer or $300 for staff per month/$500 for faculty per month, whichever is greater. 

 

 A spouse that has primary coverage with their employer may enroll in secondary coverage through the same medical plan as the employee.
 
 

Frequently Asked Question:

 
1. Who is required to complete the coordination of benefits form?
 
All employees whose spouse is enrolled in a YSU medical plan is required to complete this form. 
 
2. Is this form required to be completed annually?
 
The coordination of benefits form must be complete annually to ensure accurate coverage is provided to employees and spouses enrolled in a YSU medical plan. 
 
3.  If my spouse is not employed, self-employed, retired or a YSU employee, who would complete Part B of the coordination of benefits form?
 
Since the employee's spouse does not have an employer to complete Part B, the form should be returned without part B completed.  This is only applicable if the employee's spouse is not employed, self-employed,    retired or YSU employee. 
 
4. My spouse is only listed on my dental and/or vision coverage, am I required to complete a coordination of benefits form? 
 
No, coordination of benefits only applies to employees whose spouse is listed on a YSU medical plan. 
 
5. What is the difference between Primary Coverage and Secondary Coverage?
 
Primary medical coverage is insurance that pays the claims first on a claim for medical and hospital care.  

Secondary medical coverage is insurance provides additional coverage for dependent(s) in addition to primary medical insurance. Secondary medical insurance pays after claims are processed through the primary medical insurance coverage.  

 

6. Do I determine if my spouse is listed as primary or secondary on a YSU medical plan?

 

Under the University's Coordination of Benefits requirement, if your spouse's employer offers group medical coverage, your spouse must enroll in their employer's group medical as their primary coverage, unless your spouse:

  • works less than 25 hours per week AND
  • must pay more that 50% of the monthly single premium paid by the spouse's employer or $300 for staff per month/$500 for faculty per month, whichever is greater. 
  •  
7. Did you get my forms?

 

With the large amount of forms that the office of human resources is receiving, we cannot respond to all emails confirming receipt of documents.  Employees who submit their form through the secure upload link will receive an email confirming the forms were uploaded and sent. Employees are encouraged to submit their form through the secure upload. The link is provided above. 

 

8. Why do i continue to receive EMMA's regarding the coordination of benefits form?

 

Employees with a spouse listed on a YSU medical plan will continue to receive EMMA notifications until a coordination of benefits is received in the office of human resources.   

 

9.  Where do I send my form?

 

Coordination of Benefits can be sent electronically either through the secure benefits upload (link above) or through email to benefits@ysu.edu.