COB Date & Reason
Herc is the EE on UHC policy 02/01/2019-current. He is also covered as a SP on Humana 08/01/2022-current.
What is
COB period= 8/1/22-current
Reason=Through Spouse
TRUE or FALSE
Rules should be applied in order
What is TRUE
The policy covering the member as a subscriber is primary over the policy covering the member as a dependent
What is Rule 1
Non-Dependent/Dependent
TRUE or FALSE
The policy that has been in effect the longest will be primary for any child age 18 and over with no court order
What is
TRUE
TRUE or FALSE
Children of an intact family are updated per court order
What is
False
Ralph is the RR of a Retirement Plan through UHC effective 05/08/2021-05/31/2023 and the policy holder of a CIGNA Retirement Plan effective 05/11/2022-current.
What is
COB pd- 5/11/22-5/31/23
Reason= Per Effective Date
What is the lookback period for updating commercial coverage?
What is
12 months
A dependent child on Mom’s policy also has his own policy as a subscriber through active employment. What rule applies for primacy?
Dependent/Non-Dependent
Lisa is the subscriber on Cigna plan thru active employment. She is also covered as spouse on UHC plan. What is the correct order of benefits?
What is
Cigna Primary, UHC Secondary
What rule is used when unable to verify family dynamics?
What is
Per Effective Date
Simba is covered as a dependent under his mom’s Kaiser plan effective 11/01/2019-current and under his dad’s UHC plan effective 02/01/2018-current. The parents are divorced and there is no court order. Simba lives with Sarabi and only visits Mufasa on the weekends.
What is
COB period= 11/1/19-current
Reason= Custody Rule
TRUE or FALSE
A child is defined as child based on age
What is
False
A child of a non-intact family is covered under both parents. There is no court order, but the child resides mostly with her mother. Which rule applies for primacy?
Court Order/Custody Rule
Ariel is covered under her spouses UHC plan thru COBRA. Ariel is also covered under her ex-husband’s retirement plan thru Aetna. What is the correct order of benefits?
What is
Not enough information
Gerald is away at school and is covered by both parents. Father is subscriber on UHC. Mother is subscriber on Aetna. He is also covered on his University plan. No court order, but Gerald lives with father 9 months out of the year. What is the order of benefits?
What is
Not enough to answer
Snow is a SP under Mike's UHC policy 04/01/2019-current and also covered as SP on Nick's Aetna policy 9/1/2021-current. Per divorce decree Mike is required to cover.
What is
COB period=9/1/21
Reason= Court Decree
Medicaid policies are classified as
What is
Last Payer
Retired EE on a COBRA plan with UHC, group size under 20 is the subscriber on a BCBS plan thru active employment. Which rule applies for primacy?
What is
Per Effective Date
Vicky is covered by her father’s retirement plan (UHC), her father’s plan thru active employment (Coventry), and by her mother’s plan thru active employment (BCBS). Vicky is under 18 years of age and her mother has primary custody. There is no court order. What is the order of benefits?
What is
BCBS primary, Coventry secondary, UHC tertiary
Helen is the policyholder of a Self-Pay plan through UHC effective 08/01/2021-06/30/2023 and is the policyholder on a Coventry plan through retirement effective 07/01/2020-05/31/2023.
Who is primary?
What is
Coventry
Moana is covered as a dependent under her dad’s Kaiser plan effective 08/16/2019-current (his dob is 11/09/1971)and is required to cover. Her mom’s UHC plan effective 02/01/2018-09/30/2023 (her dob is 10/01/1971). The parents are not living together. Moana visits mom on weekends and holidays.
What is
COB period=8/16/19-9/30/23
Reason= Court Order
What are NAIC Guidelines?
What is/are
5 Rules for determining COB
Apply the rules in the correct order:
Joint Custody Rule, Active/Laid off/ Retired, Dependent/Non-Dependent, Per Effective Date, Court Order/Custody Rule, Birthday Rule, COBRA/State Continuation
What is
Dependent/Non-Dependent, Birthday Rule, Joint Custody Rule, Court Order/Custody Rule, Active, Laid off or Retired, COBRA/State Continuation, Per Effective Date
Mya is 13 and has coverage under 3 family members. CH on Aetna w/step mother DOB 8/17/81, CH on UHC w/mom DOB 4/9/86 and CH on CIGNA w/step dad DOB 10/3/85. Biological Father is court ordered to maintain coverage for her.
What is
Aetna primary, UHC secondary, Cigna Tertiary
Raquel is covered as a dependent under her step mom’s Kaiser plan effective 01/01/2018-current and under her dad’s UHC plan effective 05/01/2020-current. The parents are divorced and there is no court order. Physical and joint custody is shared.
Who is primary? Why?
What is
Kaiser Primary
Per Effective Date