State RegulationsNY specificDifficulty 2/5
An employee is covered under her own employer's group health plan and also as a dependent under her husband's group plan, both subject to Reg 62. For her claim, which plan is primary?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under Reg 62 (11 NYCRR Part 52), when a person is covered under a plan as an employee and under another plan as a dependent, the plan covering the person as an employee pays first, and the dependent coverage pays as secondary. Order-of-payment rules like this one make the coordination of benefits provision deterministic rather than a matter of insured choice. The secondary plan then limits its payment so combined benefits do not exceed actual covered expenses.
Why the other options are wrong
- A) The employee's own coverage is primary; dependent status under a spouse's plan does not jump the queue.
- C) The insured cannot choose the order of payment claim by claim; the regulation fixes which plan is primary and which is secondary.
- D) Equal splitting is not the mechanism; a fixed primary-secondary order governs, with the secondary plan paying any balance up to its normal limits.
Memory hook
Your own job plan pays first; being someone's dependent makes you second.