Question

What is the purpose of the coordination of benefits clause in group health plans?

Select one:
a. To coordinate premium payments from employees
b. To prevent duplicate premium payments from employees
c. To prevent duplicate benefit payments to employees who are insured under multiple coverages
d. To streamline insurance coverages under Medicare and Medigap

Answer 1

The purpose of the coordination of benefits clause in group health plans is to prevent duplicate benefit payments to employees who are insured under multiple coverages. It ensures that the total benefits paid do not exceed the actual cost of healthcare services received.

Step-by-step explanation:

The purpose of the coordination of benefits clause in group health plans is to prevent duplicate benefit payments to employees who are insured under multiple coverages. This clause ensures that when an employee has multiple health insurance policies, the total benefits paid do not exceed the actual cost of the healthcare services received. It helps avoid overpayment and fraud by coordinating the benefits between different insurance plans.