Insurance Licensing Virginia Life, Annuities, and Health Insurance Examination Series 11-01 Virginia-Life-Annuities-and-Health-Insurance Question # 103 Topic 11 Discussion
Insurance Licensing Virginia Life, Annuities, and Health Insurance Examination Series 11-01 Virginia-Life-Annuities-and-Health-Insurance Question # 103 Topic 11 Discussion
Medical expense Plan A pays up to $4,000. Plan B pays up to $3,000. If a person covered under both plans incurs $6,000 in expenses and Plan A is primary, which is true under the coordination of benefits provision?
A.
Plan A pays up to $6,000.
B.
Plan A pays up to $3,000 and Plan B pays up to $3,000.
C.
Plan A pays an adjusted percentage and Plan B pays the remainder.
D.
Plan A pays up to $4,000 and Plan B pays up to $2,000.
Under the coordination of benefits provision, when an individual is covered by more than one medical plan, the primary plan (Plan A) pays up to its limit first, and then the secondary plan (Plan B) pays any remaining covered expenses. In this case, since Plan A is primary, it will pay up to its maximum benefit of $4,000. After that, Plan B will pay up to its maximum benefit of $3,000, covering the remaining $2,000 in expenses.
[Reference: Virginia Life, Annuities, and Health Insurance Code, Section 38.2-3522 (Coordination of Benefits Rules), , , ]
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