In a multi-plan scenario, which statement about which plan pays first is correct?

Study for the Medical Expense Insurance Exam. Prepare with flashcards and multiple-choice questions; each has hints and explanations. Ace your exam!

Multiple Choice

In a multi-plan scenario, which statement about which plan pays first is correct?

Explanation:
Coordination of benefits sets the order in which plans pay. The primary plan pays first, up to its allowed amount. Then the secondary plan covers the remaining eligible expenses, applying its own deductible, coinsurance, and limits as applicable, for the charges that remain unpaid. This arrangement prevents double payments and ensures total benefits don’t exceed the charges. The idea that the secondary would pay first conflicts with how COB works; equal shares regardless of order ignores the established priority; and the order isn’t chosen by the policyholder but is defined by the plans’ COB rules.

Coordination of benefits sets the order in which plans pay. The primary plan pays first, up to its allowed amount. Then the secondary plan covers the remaining eligible expenses, applying its own deductible, coinsurance, and limits as applicable, for the charges that remain unpaid. This arrangement prevents double payments and ensures total benefits don’t exceed the charges. The idea that the secondary would pay first conflicts with how COB works; equal shares regardless of order ignores the established priority; and the order isn’t chosen by the policyholder but is defined by the plans’ COB rules.

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