Which of the following statements is CORRECT about the Coordination of Benefits Provision?

The Coordination of Benefits (COB) Provision is crucial in health insurance as it ensures that when an individual is covered by two or more health plans, the total benefits received do not exceed the total cost of the medical expenses. This provision specifically addresses the concern that an insured person should not profit from their coverage by receiving more benefits than the actual expenses incurred.

In this case, the statement indicating that the COB Provision prevents an insured covered by two health plans from making a profit on a covered loss is accurate. It works by coordinating the benefit payments from multiple insurers so that one policy pays its maximum allowed benefits first (the primary plan), and the other pays the remaining costs, but never exceeding the total amount owed. This mechanism ensures fairness and prevents overinsurance situations where an insured might profit financially from their medical claims.

The other statements do not encapsulate the primary purpose of the COB Provision. While it does involve the ordering of payments (like billing the primary insurer first), that is purely procedural and not the primary focus of the COB concept. Double coverage is allowed, but the primary goal is not to provide surplus benefits; rather, it's to ensure that the total payout from all plans does not exceed the actual medical expenses. Lastly, the adjustment of benefit amounts