Under a typical Coordination of Benefits clause in Group Health Insurance, how is primary coverage determined?

The determination of primary coverage under a Coordination of Benefits clause in Group Health Insurance often starts with the plan that has the earliest effective date. This approach is used because it establishes which insurance policy has been in force the longest and typically aligns with the intent to provide benefits without overlapping coverage. By using the order of effective dates, insurers can effectively minimize disputes and streamline claim processing.

In practice, if both plans cover the same individual, the plan that has been active the longest will be considered primary. This ensures that the insured receives benefits from both plans without exceeding the total amount of allowable charges, as the secondary plan will only pay after the primary plan has fulfilled its obligations.

The other options do not universally apply to all situations. The plan covering a dependent child being primary could apply in cases where the parents are separated or divorced, but it does not represent a standard rule under all circumstances. Medicare being primary has specific conditions that apply, primarily based on age or disability status, and isn't applicable across all policyholders. Lastly, the plan with higher coverage limits may provide more benefits but does not inherently determine which is primary under typical Coordination of Benefits guidelines.