State RegulationsFL specificDifficulty 3/5
A dependent child is covered under both parents' Florida group health plans, the child is not the plan subscriber of either plan, and no court decree assigns responsibility. Which plan pays primary?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under the coordination-of-benefits rules used in Florida group health policies, reflected in Chapter 627, Florida Statutes, when a dependent child is covered under both parents' plans, the plan of the parent whose birthday (month and day) falls earlier in the calendar year is primary — the 'birthday rule.' Alternate rules apply only when the parents' birthdays are the same or a court decree assigns responsibility. Custody, the parents' ages, and length of enrollment do not control.
Why the other options are wrong
- B) Custody does not determine order of benefits when the birthday rule applies; both parents' plans are coordinated by birthday order.
- C) The parents' ages are irrelevant; the rule looks to the birthday month and day, not to age.
- D) Length of enrollment in a plan does not establish order of benefits under the birthday rule.
Memory hook
Earlier birthday pays first.