LLQP Accident & Sickness · Component 1.2 · 35% of the exam
A client's group extended health plan coordinates with her spouse's plan. For their child's dental claim, the first payer is determined by:
- AWhichever parent earns the higher salary in the year the expense is incurred
- The plan of the parent whose birthday falls earlier in the calendar year, under the standard rule
- CWhichever parent submits the claim first, since coordination follows the order of receipt
- DThe plan that has paid the smaller total of claims for the family during the year
Correct answer: B) The plan of the parent whose birthday falls earlier in the calendar year, under the standard rule
Industry coordination guidelines use the earlier birthday in the calendar year to decide which parent's plan is primary for a dependent child, with the other plan paying the balance.
Why the other options are wrong
- AIncome plays no part in coordination of benefits for a dependent child.
- COrder of submission does not decide primacy; the rule does.
- DClaims paid to date do not determine which plan is primary.
Exam tip
For children, the earlier birthday in the year usually goes first.
Common mistake
Submitting a child's claim to whichever plan is most convenient.
What this tests
CISRO competency component 1.2 — Assess the client's needs and situation — which is weighted at 35% of the Accident & Sickness module. Written against the published curriculum.
More from component 1
- The single most important fact for sizing a client's disability income need is:
- A client's beneficiaries for assets are listed in the fact-finding. Why does this matter for A&S planning?
- A client asks why the agent wants to know how assets are owned (jointly or individually). In the A&S context the answer is:
- A client mentions a back injury five years ago that fully resolved. The agent should:
- Which element of a client's situation most affects the definition of disability that should be recommended?
- Which of the following health facts is most relevant to a client's disability insurance situation?
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.