State RegulationsMI specificDifficulty 2/5
An insured in Saginaw is covered under two group health plans that coordinate benefits. Under Michigan's coordination of benefits rules, what must the plans do regarding claim information?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Coordination under MCL 550.251-.255, as applied through M.C.L. 500.3402b and M.C.L. 500.3406s, depends on the plans being able to identify other coverage and confirm amounts already paid, so the plans must exchange the information reasonably necessary to coordinate. Gating that exchange behind per-claim consents or forcing the insured to broker every transfer would defeat the statute's allocation scheme.
Why the other options are wrong
- A) The coordination statute contemplates routine exchange of necessary claim information among the plans themselves.
- C) Information needed to coordinate may flow as claims require; no once-a-year limit appears in the rules.
- D) The plans, not the insured, carry the coordination workload for the information they reasonably need.
Memory hook
Plans talk to each other — that is how COB works.