Question

Jaimie's parents are divorced and both cover her on their employer-sponsored health plans. There is no documentation from the court indicating which parent should provide healthcare coverage. How does the office determine which parent's coverage is primary?

1) Alternate between the mother's and father's coverage.
2) Assume the father's coverage is primary.
3) Determine which parent has custody.
4) Bill both at the same time and whichever one pays must be primary.

Answer 1

The primary health coverage for a child with divorced parents and dual coverage is determined by the 'birthday rule', where the parent whose birthday comes first in the calendar year provides the primary coverage unless court documents state otherwise.

Step-by-step explanation:

The primary health coverage for Jaimie, whose parents are divorced and each has employer-sponsored health plans, is determined not by alternating coverage or by assuming one parent's coverage is primary. Instead, the determination of whose plan is primary is established by a set of coordination of benefits rules, which often consider the parents' birthdays. The coverage of the parent whose birthday falls earlier in the year is typically designated as the primary coverage.

This rule is commonly known as the 'birthday rule' in the insurance industry. However, if there is custody arrangement documentation that explicitly states otherwise, this documentation would take precedence over the birthday rule. It is also important to note that billing both insurances at the same time to see which one pays is not a standard or ethical practice.