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The 'coordination of benefits' (COB) provision in group health insurance is designed to prevent:
a.The insured from ever filing a claim
b.The insurer from paying any benefits at all whenever a person happens to be enrolled under more than one group plan
c.The plan from covering preventive services
d.The insured from collecting more than 100 percent of covered expenses when covered by two plans
Giải thích
Coordination of benefits applies when a person is covered by more than one group plan; it establishes which plan pays first (primary) and which pays second (secondary) so that the total reimbursement does not exceed 100 percent of the actual covered expenses. It does not bar filing claims, block preventive care, or stop the insurer from paying. COB exists to prevent duplicate payment and the profit motive that could arise from being over-reimbursed by multiple plans.
Luyện miễn phí toàn bộ 716 câu hỏi — không cần đăng ký.
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Câu hỏi liên quan cùng chủ đề
- Basic medical expense coverage differs from major medical coverage mainly because basic coverage typically:
- A 'calendar-year' deductible in a medical plan means the insured must satisfy the deductible:
- A 'family deductible' provision in a medical plan generally:
- Individual disability income policies typically limit the benefit to roughly 60 percent of the insured's earned income in order to:
- Under a 'presumptive disability' provision in a disability income policy, the insured is automatically presumed totally disabled upon:
- A 'recurrent disability' provision in a disability income policy determines:
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Đội ngũ PrepPass · Đối chiếu với California Life & Health Insurance License Exam · Quy trình kiểm tra
Người kiểm duyệt John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — kiểm tra)