Question

multiple choice question

which plan is primary if an employed patient has coverage under both an employers plan and a government-sponsored plan?

the government-sponsored plan
the employers plan
the plan with the earliest enrollment date
the plan that covers more services

Explanation:

Identify the coordination rules

Using the Coordination of Benefits and Primary Insurance knowledge points

• Under standard coordination of benefits (COB) guidelines, when an active employee is covered by both an employer-sponsored group health plan and a government-sponsored plan (such as Medicare), the employer's group health plan is generally primary.
• The government-sponsored plan acts as the secondary payer.

Evaluate the given choices

Using the Primary Insurance knowledge point

• "the government-sponsored plan": Incorrect, as government plans typically pay secondary to active employer group coverage.
• "the employer's plan": Correct, because active employment-based coverage takes precedence.
• "the plan with the earliest enrollment date": Incorrect, this rule (often related to length of coverage) only applies when other primary/secondary rules do not resolve the order.
• "the plan that covers more services": Incorrect, the scope of covered services does not determine primary versus secondary status.

Answer:

• the government-sponsored plan
• the employer's plan (Correct answer)
• the plan with the earliest enrollment date
• the plan that covers more services