CPB (Certified Professional Biller) Certification Practice Exam

How is coverage determined when both parents have different health insurance plans according to the "birthday rule"?

1. Determines coverage by primary policy only

2. Inflammation

3. Determines coverage by secondary policy only

4. Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan

The correct answer is: Determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan

The birthday rule is a guideline used to determine which parent's health insurance plan is considered primary when both parents have insurance coverage for their child. According to this rule, the plan of the parent whose birthday falls earlier in the calendar year is deemed the primary coverage. This means that the child's medical expenses will first be billed to that parent's insurance, before any claims are submitted to the other parent's insurance. The chosen answer accurately reflects that both parents’ policies can come into play. It highlights that when parents have different health insurance plans, both primary and secondary coverage can be determined based on the birthday rule. This approach ensures that the child is covered efficiently and maximizes the benefits from both insurance plans. Understanding the implications of this rule is critical for healthcare providers and billers to ensure proper billing and to avoid claim denials. This also helps in coordinating benefits to ensure that the maximum coverage is utilized for medical expenses.