Indiana State Life and Health Insurance Practice Exam

Disable ads (and more) with a membership for a one time $4.99 payment

Prepare for the Indiana State Life and Health Insurance Exam. Study with comprehensive flashcards and multiple-choice questions, each featuring detailed hints and explanations. Achieve success and ace your exam!

Practice this question and more.


If Jill is covered under two Group Health policies, which provision dictates the primary coverage?

  1. Replacement

  2. Time Payment of Claims

  3. Notice of Claim

  4. Coordination of Benefits

The correct answer is: Coordination of Benefits

Coordination of Benefits is the correct provision that determines how benefits are distributed when an individual is covered by multiple health insurance policies. When someone like Jill has two Group Health policies, this provision outlines how the insurers will collaborate to provide coverage. Typically, one insurance policy will be considered the primary policy, which pays first for covered expenses, while the secondary policy pays for remaining eligible costs up to its limits. The determination of which policy is primary often follows a specified set of rules, such as the type of coverage, who is the policyholder, or the order in which the policies were obtained. This system is designed to avoid overpayment and ensures that the insured individual receives optimal benefits from both policies without exceeding the necessary medical expenses. The other options are provisions related to insurance claims and adjustments, but they do not directly specify how to prioritize coverage when multiple policies are involved. Therefore, they do not apply to determining which policy provides primary coverage in this scenario.