55. If two group health insurance plans have coordination of benefits provisions, the plan that pays first is called the:
Answer: C
The plan that pays first is called the Primary plan.
In the context of coordination of benefits provisions in group health insurance, the plan that pays first is referred to as the primary plan.
A) Master contract
A master contract is a legal agreement that outlines the terms and conditions of an insurance policy, but it does not specifically refer to the order of payment among multiple insurance plans. Therefore, this option is not relevant to the question regarding coordination of benefits.
B) Qualified plan
A qualified plan generally refers to a health plan that meets certain regulatory standards, such as those set by the Affordable Care Act. While important in the context of health insurance, it does not designate which plan pays first in a coordination of benefits scenario.
C) Primary plan
The primary plan is the insurance policy that is responsible for paying first when an individual is covered by multiple plans. This term is central to understanding coordination of benefits, as it directly addresses which plan has the primary obligation to pay claims.
D) Comprehensive major medical plan
A comprehensive major medical plan is a type of health insurance that provides a wide range of coverage for various medical expenses. However, it does not specifically indicate which plan pays first among multiple insurance policies, making it an incorrect choice in this context.
Conclusion
The primary plan is clearly defined as the insurance that pays first under coordination of benefits provisions, making it the correct answer. Other options describe different aspects of insurance policies but do not pertain to the specific function of determining the order of payment among multiple plans.