Enactment of Coordination of Benefits Rules in Employee Retirement Income Security Act of 1974 [Public Law 93–406]

ERISA does not provide guidance on how Group Health Plans should coordinate benefits as a secondary payer; whereas, state insurance regulations and the FEHB do provide guidance mainly based on the NAIC MDL-120 regulation. Under MDL-120, a secondary payer will determine a benefit as if they were the primary payer then will provide their benefit paying the lesser of what they would have paid or the balance after the primary payer has provided its benefit. Some self-funded plans apply deductibles twice, when they determine the benefit and to balances resulting in no benefit being paid despite being paid a premium as if they are the only health coverage. Self-funded health insurance plans should be made to follow the same rules as other insurers. Amend ERISA to include Coordination of Benefits