Esther, age 42, and Peter, age 39, are married and have a son, Jimmy, age 4. Esther
Question:
Esther, age 42, and Peter, age 39, are married and have a son, Jimmy, age 4. Esther works at a bank, and is covered under her employer’s group medical insurance plan as a full-time employee. Esther is also covered under her husband, Peter’s group medical insurance plan, as a dependent. Also, Peter works at a hospital, and is covered under his employer’s group medical insurance plan as a full-time employee. Peter is also covered under his wife, Esther’s group medical insurance plan, as a dependent. Their son, Jimmy, is covered under both Esther’s and Peter’s group medical insurance plan as a dependent. Esther’s birthday is 1 October 1980 while Peter’s birthday is 15 March 1983. The group medical insurance plans of both Esther and Peter have the same coordination-of-benefits provision.
i. If Esther is hospitalized, in response to her medical bills/ expenses, which group medical insurance plan is the primary and which group medical insurance plan is the excess?
ii. If Peter is hospitalized, in response to his medical bills/expenses, which group medical insurance plan is the primary and which group medical insurance plan is the excess?
iii. If the son, Jimmy, is hospitalized, in response to his medical bills/expenses, which group medical insurance plan is the primary and which group medical insurance plan is the excess?
iv. If Esther and Peter get divorced, and Peter is awarded custody of his son, Jimmy. However, there is no court order specifying who is responsible for Jimmy’s medical/health care expenses. If Jimmy is hospitalized after the divorce, in response to his medical bills/expenses, which group medical insurance plan is the primary and which group medical insurance plan is the excess?
v. Suppose that Esther and Peter get divorced, and Peter is awarded custody of his son, Jimmy. There is a court order specifying that Esther must provide health/medical insurance for her son, Jimmy. If Jimmy is hospitalized after the divorce, in response to his medical bills/expenses, which group medical insurance plan is the primary and which group medical insurance plan is the excess?
Principles of Risk Management and Insurance
ISBN: 978-0132992916
12th edition
Authors: George E. Rejda, Michael McNamara