State RegulationsOH specificDifficulty 3/5
A child is covered as a dependent under both parents' group health plans, and no court decree governs the child's coverage. Under the standard order-of-benefits rule used with coordination-of-benefits provisions in Ohio, which plan is primary for the child's claims?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The standard COB dependent-child rule (the birthday rule) makes the plan of the parent whose birthday falls earlier in the calendar year primary for a child covered under both parents' plans, yielding to a court-decree rule when one applies. This order-of-benefits logic is the method used under coordination-of-benefits provisions recognized by the Ohio Department of Insurance to avoid duplicate payment.
Why the other options are wrong
- B) The father's plan is not automatically primary; the earlier calendar-year birthday controls.
- C) The mother's plan is not automatically primary; the earlier calendar-year birthday controls.
- D) Length of time in effect does not determine primacy for a dependent child; the birthday rule does.
Memory hook
Earlier birthday wins the primary seat for the kids.