CPB Certified Professional Biller Certification Practice Exam

What does the birthday rule help to establish?

1. The primary policyholder in a child’s healthcare coverage

2. The cost of medication for a patient

3. The duration of a hospital stay

4. The age limit for insurance coverage

The correct answer is: The primary policyholder in a child’s healthcare coverage

The birthday rule is a guideline used in coordination of benefits to determine which parent's insurance plan is primary for a child when both parents have health insurance coverage. According to this rule, the plan of the parent whose birthday falls earlier in the calendar year is typically considered the primary insurance for the child. This helps to establish which policy will pay first for healthcare services, ensuring that claims are processed efficiently and correctly. The other options don't relate directly to the core purpose of the birthday rule. For instance, the cost of medication, the duration of a hospital stay, and the age limit for insurance coverage are determined by various other factors and regulations, rather than by the birthday rule itself. Thus, your choice about the birthday rule establishing the primary policyholder in a child's healthcare coverage is indeed the correct interpretation.