State RegulationsNY specificDifficulty 2/5
Under New York's coordination of benefits rules for group health plans, when a person is covered by more than one plan, the primary plan:
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under Reg 62 (11 NYCRR Part 52), New York's coordination of benefits rules determine the order of payment when a person is covered by more than one health plan. The primary plan pays its benefits as if no other coverage existed; the secondary plan then coordinates its payment in light of what the primary paid. The primary's liability is never reduced because other coverage exists.
Why the other options are wrong
- A) Paying only what another plan declines describes a secondary plan, not the primary.
- B) Equal splitting is not the method; each plan pays under the order-of-benefits rules.
- C) The issuance date of the policy is not what determines primacy.
Memory hook
Primary pays blind to other plans; secondary does the coordinating.