Certified Clinical Medical Assistant CCMA Practice Test

An adolescent is covered by two insurance policies under her divorced parents who have birthdays in May and August and have joint custody. Which policy is the primary policy for the adolescent?

1. The policy of the parent who has the latest birthday month.

2. The policy of the parent who has the earliest birthday month.

3. The policy of the parent who is the custodial parent.

4. The policy of the parent who has the most coverage.

The correct answer is: The policy of the parent who has the earliest birthday month.

The primary policy for the adolescent will be determined by the birthday rule, a common guideline used in coordinating benefits when a child is covered by more than one health insurance policy. According to this rule, the parent's policy that has the earliest birthday in the calendar year provides primary coverage for a dependent child. In this scenario, since one parent has a birthday in May and the other in August, the policy belonging to the parent with the May birthday is considered the primary policy. This is because it adheres to the birthday rule, which focuses on the month of birth rather than the parent's status (like custodianship or coverage amount). Consequently, covering the child under the primary policy first ensures that the most comprehensive benefits are utilized before any secondary coverage is applied.