36. Jack was born in August of 1966. His wife Mary was born in March of 1968. They both work and each is covered by a Major Medical plan provided by their employer. For their 2 dependent children
Answer: A
Jack's plan is primary and Mary's is secondary.
In situations where both parents have health insurance coverage, the plan of the parent whose birthday comes first in the calendar year is considered primary. Since Jack was born in August 1966 and Mary in March 1968, Jack's plan is primary.
A) Jack's plan is primary and Mary's is secondary.
This option is correct because it follows the standard rule of coordination of benefits, which states that the plan of the parent whose birthday is earlier in the year takes precedence. Since Jack's birthday is before Mary's in the calendar year, his plan is designated as the primary coverage for their dependent children.
B) Mary's plan is primary and Jack's is secondary.
This option is incorrect because it contradicts the coordination of benefits rule. Mary's birthday occurs later in the year than Jack's, which means her plan cannot be primary for their children’s coverage according to the established birthday rule.
C) Jack's plan covers the older child and Mary's the younger child.
This option is incorrect as it misinterprets the coordination of benefits. The primary and secondary plans are not determined by the age of the children but rather by the birth dates of the parents. Therefore, both children would be covered under the primary plan first, regardless of their age.
D) The two companies cover the children on a pro rata basis.
This option is also incorrect. Pro rata coverage would imply that both plans would share the costs equally, which is not how coordination of benefits typically works when one plan is designated as primary. In this case, Jack's plan would pay first, and any remaining costs would be submitted to Mary's plan.
Conclusion
Jack's plan being primary and Mary's being secondary is the correct interpretation based on the birthday rule in health insurance coordination of benefits. All other options fail to adhere to this fundamental principle, making them incorrect in the context of determining which plan covers their dependent children.