State RegulationsFL specificDifficulty 2/5
Under a Florida group health plan's coordination-of-benefits provision, how does the secondary plan pay a claim?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
When one plan pays primary, the secondary plan pays the balance of the covered expense, up to but never more than the amount it would have paid had it been primary, so total benefits never exceed the actual covered expense. Under Chapter 627, Florida Statutes, this is how coordination of benefits prevents duplication and overinsurance when coverage overlaps. The secondary plan neither disappears, double-pays, nor steps into the primary role.
Why the other options are wrong
- A) The existence of other coverage does not disqualify claims; it only triggers coordination between the plans.
- B) Duplicate full payment is exactly what coordination of benefits exists to prevent.
- D) The secondary plan does not pay first and then recoup from the primary; the order-of-benefits rules set which plan pays first.
Memory hook
Secondary fills the gap — never more than primary.