Final answer:
The birthday rule determines the coordination of John's dental insurance coverage. He cannot make a profit from the insurance payments, as they are coordinated to cover no more than 100% of the services provided. The employer mandate ensures access to insurance, but does not entitle individuals to earn money from healthcare claims.
Step-by-step explanation:
When John has dental insurance through his employment and additional coverage through his wife's employer, the birthday rule is typically invoked to coordinate benefits. This rule determines the order in which the two insurance plans will pay, with the plan of the person whose birthday occurs earlier in the calendar year deemed the primary payer and the other plan as the secondary payer. It is important to note that rather than making money on the deal, insurance plans have coordination of benefits clauses that prevent paying more than the total charge of the services provided. Therefore, the primary insurer pays its share first, and the secondary insurer only covers what is left up to the charge's total, not exceeding 100% of the billed amount.
John would not be able to ‘profit’ from the insurance as any seeming overpayment would typically be credited against future benefits or possibly refunded to the payer. With the employer mandate, both insurances through the employers would not aim to cover more than the total charge of the dental services provided. The intention behind the employer mandate is to ensure that employees have access to insurance, but it does not stipulate over-insurance to the extent that beneficiaries make money from their healthcare claims. Additionally, having insurance doesn't necessarily mean adequate coverage is present. Some individuals may still experience significant out-of-pocket costs, becoming underinsured, where their medical expenses greatly impact their income.