LLQP Accident & Sickness · Component 1.2 · 35% of the exam
An employee asks whether she can claim both her own group plan and her spouse's for the same dental bill. The correct explanation is:
- AYes, and she may receive up to twice the cost, since two contracts each promise to pay
- Yes, but coordination limits total reimbursement to the eligible expense actually incurred
- CYes, provided she submits both claims on the same day to the same adjudication service
- DNo; only one plan may ever be used, and the second plan's premium is wasted
Correct answer: B) Yes, but coordination limits total reimbursement to the eligible expense actually incurred
Coordination of benefits allows the second plan to cover what the first did not, up to the eligible amount, which is what makes dual coverage valuable without creating a profit.
Why the other options are wrong
- ACoordination prevents any claimant from recovering more than the expense.
- CThe claims are submitted in sequence, and the date of filing does not change the rule.
- DThe second plan pays the balance, so it is far from wasted.
Exam tip
Dual coverage fills the gap; it does not double the benefit.
Common mistake
Promising a client twice the reimbursement from two plans.
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.