Coordination of Benefits (F.S. 627.4235)

Florida group hospital/medical/surgical policies must carry a COB provision coordinating with similar benefits under any other group policy for the same loss — and an insurer may reduce or refuse duplicate benefits ONLY if, together, the coordinating insurers pay 100% of total reasonable expenses. Pay order for a working senior covered three ways: (1) the plan covering him as an employee, (2) the plan covering him as a dependent, (3) Medicare last. Dependent children of married parents: the birthday rule — the parent whose birthdate falls earlier in the year pays first; identical birthdates → the plan that has covered its parent longest. Divorced/separated parents: (1) custodial parent's plan, (2) the custodial parent's spouse's plan, (3) the noncustodial parent's plan. COB is NOT permitted against an indemnity-type policy, an excess policy, a specified illness/accident policy, or a Medicare supplement policy.

Plans take turns so the bills get paid once, in full, and nobody profits. Fixed-payout and Medigap policies sit outside the coordination game entirely.