CPB Certified Professional Biller Certification Practice Exam

The "birthday rule" helps determine coverage in situations where:

1. One parent is older

2. Both parents have insurance plans

3. Only one parent has insurance

4. No insurance is available

The correct answer is: Both parents have insurance plans

The "birthday rule" is a guideline used in determining which parent's health insurance plan will be the primary coverage for a dependent child when both parents have insurance plans. Under this rule, if the child is covered by two plans, the plan of the parent whose birthday falls earlier in the year is typically designated as the primary insurer. This is particularly relevant for coordinating benefits and ensuring that billing is processed correctly between the two insurance providers. In cases where only one parent has insurance, the birthday rule does not apply, as there is no competing plan to consider for primary and secondary coverage. Similarly, if no insurance is available, the rule has no relevance since there are no plans to coordinate. Therefore, this rule is specifically pertinent in situations where both parents maintain their own insurance plans, highlighting its role in navigating insurance coverage for dependents effectively.