Florida 2-15 Life, Health and Variable Annuity AgentFlorida Laws and Regulations Specific to Health InsuranceMedium
A Florida resident is covered by a group health insurance policy through their employer. The policy contains a Coordination of Benefits (COB) provision. The insured also has individual health coverage. If the resident incurs medical expenses, which policy is typically considered primary under standard COB rules when both policies cover the same loss?
- AThe policy of the person whose birthday comes earlier in the year will be primary, if applicable.
- BThe individual health coverage will always be primary.
- CThe policy that has been in effect the longest will be primary.
- DThe group health insurance policy will always be primary.
Show answer & explanationAnswer & explanation
Correct answer: D. The group health insurance policy will always be primary.
Under standard Coordination of Benefits (COB) rules, when an individual is covered by both group and individual health insurance, the group policy is almost always considered primary. This is a fundamental principle of COB.
Why the other options are wrong
- A. The 'birthday rule' applies when a child is covered under two parents' group policies, not for an individual covered by both group and individual plans.
- B. Individual policies are typically secondary to group policies under COB rules.
- C. While 'length of coverage' can be a tie-breaker in some COB scenarios (e.g., two group policies), it's not the primary rule for group vs. individual.
COB: Group vs. Individual
Coordination of Benefits (COB) rules determine which policy pays first when an individual has multiple health coverages.
- Prevents overpayment of benefits.
- Group policies are generally primary over individual policies.
- Other rules apply for specific situations (e.g., children, Medicare).
Memory trick: COB ensures bills are split, not double-paid, with Group always first in line.