What if a patient has a procedure that is covered as both a “standard” benefit and an EHB benefit in a plan?
There is no coordination of benefits (COB) between the standard and EHB benefits. Only one set of benefits will cover the procedure. Having both EHB and non-EHB benefits does not mean the patient will receive complete coverage.
Consider this example: if the procedure code is in the EHB list AND the patient is under the age limit, EHB benefits are used to pay that code. If the procedure code is NOT in the EHB list, the standard benefits are used to pay that code, regardless of the patient’s age.