Most group health insurance plans have adopted the coordination-of-benefits rules developed by the National Association of Insurance Commissioners.
Under these rules, if a dependent child is covered by both of the health insurance plans of the child's married parents, which health plan is primary for the child's medical expenses?
A) always the mother's plan
B) always the father's plan
C) the plan of the parent whose birthday occurs first in the calendar year
D) the plan of the parent who works for the larger employer, based on number of total employees
Question 2
Tracy is covered by a group dental insurance plan at work. At her latest check-up, the dentist notes that she needed crowns on two teeth.
Under her plan, if the cost of dental work will exceed 500, the dentist submits the treatment plan to the insurer to calculate what the plan will cover and what the employee will pay. This provision is known as a
A) mandatory second opinion.
B) underwriting review.
C) predetermination of benefits.
D) claims audit.
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