CARD Q071
A person has two health plans. What is the primary purpose of coordination of benefits?
- Require the plan with the lower deductible to pay first
- Divide each expense equally between the plans
- Determine payment order and coordinate benefits under the plans
- Allow the member to choose the primary payer for every claim
Determine payment order and coordinate benefits under the plans
Coordination establishes primary and secondary responsibilities and helps avoid duplicate expense reimbursement beyond the applicable limits.
Why each choice is right or wrong
A. Require the plan with the lower deductible to pay first
Incorrect. Payment order is not simply determined by the lowest deductible.
B. Divide each expense equally between the plans
Incorrect. The plans do not automatically split every bill equally.
C. Determine payment order and coordinate benefits under the plans
Correct. Coordination establishes primary and secondary responsibilities and helps avoid duplicate expense reimbursement beyond the applicable limits.
D. Allow the member to choose the primary payer for every claim
Incorrect. Members cannot freely choose the primary payer contrary to coordination rules.
Review the related terms
Use these lessons to revisit the concepts and try additional practice questions.