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

To determine which parent's health insurance coverage is primary for a child, the office typically uses the 'birthday rule'. The parent whose birthday comes first in the calendar year provides the primary coverage, not based on the year they were born or other factors.

Step-by-step explanation:

When determining which parent's employer-sponsored health insurance coverage is primary for Jaimie, the office typically follows the 'birthday rule.' The birthday rule states that the parent whose birthday (month and day, not year) occurs first in the calendar year has the primary coverage for the children. It's not about whose policy started first or who is older; it simply goes by the birthday. If one parent has custody, that parent's plan may become primary by default. It is incorrect to alternate between the parents' coverage, assume the father's coverage is primary, or bill both and choose the one that pays first. Correct coordination of benefits should happen pursuant to established rules to prevent issues and ensure that both insurances work together effectively.