Health Insurance Mastery Practice Exam

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Master the Health Insurance Exam with insightful questions and detailed explanations. Prepare effectively with comprehensive flashcards and multiple-choice questions. Ace your test confidently!

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Under the Model Coordination of Benefits Act, what is the status of an insured's policy if they are covered by both their employer's and their spouse's plan?

Secondary
Primary
Tertiary
Subordinate

The correct answer is: Primary

When an insured is covered under both their employer's health plan and their spouse's plan, the primary coverage is determined by the rules set out in the Model Coordination of Benefits Act. In general, the insured's own employer-sponsored policy is considered primary when the insured is the employee. This means that the employer's plan pays first for any claims, and the spouse’s plan would then act as secondary, covering remaining eligible expenses after the primary insurance has paid. This approach prevents duplication of benefits and ensures a more organized method of handling claims. Therefore, the status of the insured's own employer's policy in this scenario is classified as primary, effectively making it the first line of defense in the payment of medical expenses.