Certified Revenue Cycle Representative (CRCR) Practice Exam

Self-funded benefit plans may choose to coordinate benefits using which rule besides the gender rule?

1. Age rule

2. Birthday rule

3. Employment rule

4. Income rule

The correct answer is: Birthday rule

Self-funded benefit plans often have the option to coordinate benefits using different rules to determine primary and secondary payers for medical expenses. The birthday rule is a method used when determining which parent's insurance plan pays first when a child is covered by both parents' plans. Under this rule, the plan of the parent whose birthday comes first in the calendar year is designated as the primary payer, regardless of the year of birth. This approach is widely accepted because it is straightforward and easy to apply. Employing the birthday rule can help reduce administrative burdens and disputes about which plan is primary, facilitating quicker claims processing. Other potential rules, such as the age rule, employment rule, or income rule, do not have the same level of recognition or applicability in this context. The age rule may suggest that the plan covering the older individual pays first, but it's less commonly employed than the birthday rule. Hence, the birthday rule is the appropriate choice when coordinating benefits for self-funded plans alongside the gender rule.