Certified Medical Assistant Practice Exam

When both parents (married) are covered by health insurance, claims for the family are paid according to the

1. Single-parent rule

2. Dependent hierarchy

3. Mother's coverage

4. Birthday rule

The correct answer is: Birthday rule

The birthday rule is a method used by health insurance companies to determine which parent's plan will be the primary payer for a dependent child's medical claims when both parents have insurance coverage. According to this rule, the policy of the parent whose birthday occurs first in the calendar year will be considered primary. The day and month of the birthday are taken into account, rather than the age of the parents. This approach helps streamline the billing and payment process for healthcare services, ensuring that there is a clear determination of which insurance will cover the costs first. The secondary insurance can then cover any remaining balances as outlined by its policy. This rule helps avoid confusion and simplifies coordination of benefits between the two health insurance plans. In contrast, the other choices, such as the single-parent rule or dependent hierarchy, do not align with standard practices used in determining primary coverage in dual-parent situations. Similarly, while the mother's coverage might be considered under different circumstances, it is not a guideline followed in most insurance policies when determining which plan has priority for payment. The birthday rule remains a widely accepted practice in managing insurance claims for children under the coverage of both parents.