Which clause in a health insurance policy helps protect against accidental over-insurance?

The Coordination of Benefits clause is designed to prevent accidental over-insurance when an individual is covered by more than one health insurance policy. This clause outlines how claims will be handled when multiple insurance providers are involved, ensuring that the total amount of benefits paid does not exceed the total medical expenses incurred.

When a person has coverage from multiple plans, Coordination of Benefits determines the primary and secondary insurers. The primary insurer pays first, up to the limits of that policy, while the secondary insurer can pay the remaining balance, but only to the extent that does not exceed the total cost of the claim. This process protects against over-insurance, as it ensures that the total payout from both insurance policies does not lead to a profit on the medical expenses but rather serves to cover them appropriately.

The other options, such as Subrogation, which involves the insurance company seeking reimbursement from a third party after paying a claim, the Deductible Clause, which outlines the amount the insured must pay out of pocket before coverage kicks in, and the Exclusion Clause, which specifies certain conditions or circumstances that are not covered by the policy, do not serve the primary purpose of preventing over-insurance situations.