A family of five is covered by multiple insurance companies: • Father Jones work
ID: 127636 • Letter: A
Question
A family of five is covered by multiple insurance companies: • Father Jones works for a private firm, has his primary health insurance (ABC) through work, and secondary health insurance (XYZ) through his wife. • Mother Jones works for the state the Jones family resides in, has health insurance through work, and life insurance through her husband. • Sally Smith is covered under her mother’s health insurance policy until the age of 24. • Jeff Jones works at a bookstore and is covered under his father’s life insurance policy. • Nikki Jones is covered under both of her father and mother’s policies Determine the coordination of benefits for each family member for the visits listed in the table below. The first visit is completed as an example: Father Jones has the flu and goes to the doctor. Primary insurance is ABC and secondary is XYZ because his insurance is primary for his visits.
secondary is XYZ because his insurance is primary for his visits.
Patient Name
Family Relationship
Date of Birth
Type of Insurance
Reason for Visit
Order of Insurance
Primary
Secondary
Explanation
Father Jones
Father of the Jones family
Works for a private firm
5/14/1968
ABC
Flu
Primary ABC
Secondary XYZ
His insurance is primary for his visits
Mother Jones
Mother of the Jones family
Works for the state
04/13/1969
XYZ
Annual examination
Sally Smith
Daughter of Mother Jones from her first marriage
1/1/1993
Covered under Mother’s XYZ policy until the age of 24
Annual examination
Jeff Jones
Son of Father Jones from his first marriage
Works at Barnes Books
12/25/2000
Covered under Father’s ABC policy
Books fell on his head at the bookstore he works for
Nikki Jones
Daughter of Father and Mother Jones
4/15/2005
Covered under both Father’s ABC and Mother’s XYZ policies
Annual examination
Patient Name
Family Relationship
Date of Birth
Type of Insurance
Reason for Visit
Order of Insurance
Primary
Secondary
Explanation
Father Jones
Father of the Jones family
Works for a private firm
5/14/1968
ABC
Flu
Primary ABC
Secondary XYZ
His insurance is primary for his visits
Mother Jones
Mother of the Jones family
Works for the state
04/13/1969
XYZ
Annual examination
Sally Smith
Daughter of Mother Jones from her first marriage
1/1/1993
Covered under Mother’s XYZ policy until the age of 24
Annual examination
Jeff Jones
Son of Father Jones from his first marriage
Works at Barnes Books
12/25/2000
Covered under Father’s ABC policy
Books fell on his head at the bookstore he works for
Nikki Jones
Daughter of Father and Mother Jones
4/15/2005
Covered under both Father’s ABC and Mother’s XYZ policies
Annual examination
Explanation / Answer
Patient name
Family relationship
Date of birth
Type of insurance
Reason for visit
Order of insurance
explanation
Mother jones
Mother of jones family works for the state
13.4.69
XYZ
Annual examination
XYZ
Her insurance is primary for her visits
Sally smith
Daughter of mother jones
1.1.93
Covered under XYZ policy till 24
Annual examination
secondary
She will be covered under her mother’s insurance because she is in 24 years of age and so she can utilize this coverage insurance in XYZ.
Jeff jones
son
25.12.
ABC policy
Books fell on his head at the store
ABC primary
He is covered in ABC policy and it is the emergency situation
Nikki jones
daughter
15.4.2005
Both policies
Annual examination
XYZ
It requires only basic health examination that can be easily insured in XYZ policy
Patient name
Family relationship
Date of birth
Type of insurance
Reason for visit
Order of insurance
explanation
Mother jones
Mother of jones family works for the state
13.4.69
XYZ
Annual examination
XYZ
Her insurance is primary for her visits
Sally smith
Daughter of mother jones
1.1.93
Covered under XYZ policy till 24
Annual examination
secondary
She will be covered under her mother’s insurance because she is in 24 years of age and so she can utilize this coverage insurance in XYZ.
Jeff jones
son
25.12.
ABC policy
Books fell on his head at the store
ABC primary
He is covered in ABC policy and it is the emergency situation
Nikki jones
daughter
15.4.2005
Both policies
Annual examination
XYZ
It requires only basic health examination that can be easily insured in XYZ policy
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