Final answer:
When a claim has coverage under multiple health plans, the coordination of benefits provision determines which plan pays first and which pays second.
Step-by-step explanation:
When a claim has coverage under more than one health plan, the group medical plan provision that applies is known as coordination of benefits (COB). COB is a process that determines the order in which multiple health insurance plans pay benefits for a claim. The goal of COB is to ensure that the total payment does not exceed 100% of the allowed charges.
For example, if a person is covered under both their own group health plan and their spouse's group health plan, the COB provision will determine which plan is the primary payer and which plan is the secondary payer. The primary plan pays benefits first, up to its coverage limits, and the secondary plan pays any remaining costs that are covered by its plan.