State RegulationsMI specificDifficulty 2/5
A Kalamazoo employee is covered both under her own employer's group health plan and as a dependent under her spouse's employer plan. Under Michigan coordination of benefits rules, which plan pays her claims first?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under Michigan's coordination of benefits statute, MCL 550.251-.255, a plan that covers a person as an employee or member pays before a plan that covers the same person as a dependent. M.C.L. 500.3402b applies this coordination scheme to group accident and health coverage, so the employee's own plan is primary and the spouse's plan is secondary for her claims.
Why the other options are wrong
- A) Breadth of family coverage is not a coordination factor; coverage as an employee versus a dependent controls.
- C) The insured cannot choose the payment order; the statute fixes the order of benefits.
- D) Premium level is irrelevant to determining which plan is primary.
Memory hook
Your own plan pays first; the spouse's plan picks up second.