question

Point of Service collection

answer

Collecting the patient's portion of the bill at the time the service is rendered

question

Financial Pre-Determination

answer

Method through which the provider identifies the actual payment sources and assists the patient in determining expected reimbursement, their out of pocket expenses, and alternative funding sources

question

Emergency Medical Treatment and Active Labor Act (EMTALA, 1986)

answer

Federal law enacted by the CMS to protect patients against discrimination based on economic status and mandates patients are screened and stabilized when seeking emergency care or are in active labor

question

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

answer

Nation's oldest and largest standards-setting and healthcare accrediting body that works to improve quality of healthcare by initiating performance improvement services; Independent, not-for-profit

question

Board of Commissioners

answer

Joint Commission's governing body that provides policy leadership and oversight

question

Standards for Hospital Accreditation (Rewritten 1970)

answer

Published by TJC; Represent optimal achievable levels of quality, instead of minimum essential levels of quality, and registered nurses, administrators, and physicians conducted accreditation surveys

question

Social Security Act (Amended 1972)

answer

Required that the Secretary of the U.S. Department of Health and Human Services (DHHS) validate and evaluate Joint Commission findings; The Joint Commission then changed its name to JCAHO in 1987

question

Accreditation Manual for Hospitals (1993)

answer

Reorganization around important patient care and organization functions shifting the focus from standards that measure capability to perform those that look at its actual performance

question

Office of Inspector General (OIG)

answer

Offers a voluntary compliance program under a designated compliance officer that helps to improve quality of care, reduce fraud, reduce waste and abuse, and reduce cost of healthcare to federal, state, and private health insurers

question

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

answer

1) Protects patient's private information (PHI) 2) Encourages electronic transactions 3 Requires safeguards to protect the security and confidentiality of PHI 4) Portability 5) Funds combats of fraud and abuse

question

Portability in HIPPA

answer

Once a person has insurance coverage, when they change health plans (ex. change jobs) the previous coverage may be used to reduce or eliminate any pre-existing condition exclusions that might apply under the new plan

question

The Privacy Rule

answer

Permits certain incidental uses and disclosures which occur as a by-product of permissible disclosures, as long as reasonable safeguards were applied and the minimum necessary standard was implemented by the heath care entity

question

Minimum necessary policies

answer

Policies based on job duties that limit how much PHI is used, disclosed, and requested for certain purposes

question

Information Services

answer

1) Integrated support for all departments with entire health organizations 2) Identify patients or records uniquely 3) Automated functions in the financial, clinical, and administrative areas 4) Obtain reimbursement for services rendered 5) Easier access to clinical/administrative data 6) Save time by automating tasks

question

2 common ways data is transmitted:

answer

1) Batch processing 2) Interfaces

question

Batch processing

answer

Many transactions are stored and sent on a pre-scheduled or demand basis

question

Interfaces

answer

Software takes data from one system and sends it to another frequently reformatting it tore acceptable to the system

question

IHN

answer

Integrated Healthcare Networks (evolved from traditional independent hospitals)

question

Master Patient Index (MPI)

answer

1) Uniquely identifies the health system's entire population 2) Stores key identifying data on each patient

question

Clinical Data Repository (CDR)

answer

Provides ready access to information from a variety of sources within a healthcare delivery network

question

Clinical Data Repository (CDR)

answer

Clinical data from ancillary services will be integrated into a single, long term record for the patient; may provide the ability to trend analysis

question

U.S. Uninsured Help Line

answer

Helps the 6.8 million uninsured Californians get coverage

question

Partnership for Prescription Assistance

answer

National program to help patients in need get access to prescription medicines

question

Health insurance

answer

Coverage for medical expenses a patient could incur as a result of illness or injury

question

Policyholder (Subscriber)

answer

Person who contracts with the insurance company for healthcare coverage

question

Policyholder for BlueCross, Commercial, and PPO

answer

Policyholder person whose name appears on the insurance card

question

Policyholder for HMOs

answer

Each insured person has his/her own card; patient must be asked Policyholder = 00 or 01 Spouses = 01 or 02 Dependents = 03, 04, etc.

question

Policyholder for Tricare (formerly Champus/Champva)

answer

Policyholder sponsor or active/retired military personnel

question

Policyholder for Medicare/Medicaid

answer

Policyholder ALWAYS the patient

question

Policyholder for Workers' Compensation

answer

Policyholder is usually the employer

question

Centers for Medicare and Medicaid Services (CMS)

answer

Federal agency within the U.S. Dept. of Health and Human Services (DHS) responsible for administering the largest federal health programs; Works with Health Resources and Services Administration to run CHIPs

question

Business Centers within CMS

answer

1) Center for Beneficiary Choices 2) Center for Medicare Management 3) Center for Medicaid and State Operations

question

Children's Health Insurance Program (CHIP)

answer

Program for uninsured children in the U.S.

question

CMS' Mission

answer

To assure health security for its beneficiaries

question

CMS' Vision

answer

To lead the Nation's healthcare system toward improved health for all

question

Health Care Quality Improvement Initiative

answer

CMS initiative emphasizing systematic assessment of patterns of care and outcomes for beneficiaries

question

CMS

answer

Partners with other quality-focused organizations (PROs and ERSD Network Organizations) engaging in national projects aimed at improving the processes and outcomes of care for beneficiaries

question

Peer Review Organization (PROs)

answer

1) Program administered by CMS that monitors and improves utilization and quality of care for Medicare beneficiaries 2) Consists of 53 Quality Improvement Organizations responsible for each U.S. state, territory, and the District of Columbia

question

PRO Mission

answer

To ensure: 1) Quality 2) Effectiveness 3) Efficiency 4) Economy of health care services

question

PRO Functions

answer

1) Conduct Cooperative Quality Improvement Projects (examination and improvement) 2) Provide Beneficiary Protection and Education (mandatory case review and outreach activities)

question

CMS

answer

Leads the health care industry in the use of electronic technology for all phases of claims processing, reducing administrative costs

question

Medicare Transaction System

answer

Requirement under HIPAA that should bring greater efficiency to the processing and payment of claims, and better service info needs of consumers and providers

question

Relative Value Resource Based System (RVRBS)

answer

1) Replaced payment system based on historic patterns 2) National fee schedule based on the work and overhead costs associated with each medical service

question

Prospective Payment System

answer

1) Reduced growth rate of Medicare outlays for hospital IP services 2) DRG system that allows hospitals to operate more efficiently, controlling costs without reducing quality of care

question

Diagnosis Related Group (DRG) System

answer

Pays hospitals a fixed amount per patient based on diagnosis; Prospective Payment System

question

Ambulatory Payment Groups (APGs); Ambulatory Payment Classification System (APCs)

answer

CMS outpatient payment system that covers episodes of care for a particular medical diagnosis; excludes Behavioral Health

question

Social Security Act (Title XVIII)

answer

Public or private entities and agencies may participate in the administration of the Medicare program under agreements or contracts entered into with CMS

question

Medicare Contractors

answer

Fiscal intermediaries and carriers

question

Fiscal Intermediaries

answer

Medicare contractors that perform bill processing and pay benefits for Medicare Part A

question

Carriers

answer

Medicare contractors that perform claims processing and benefit payment functions for Part B

question

Intermediaries and Carriers

answer

Perform program integrity activities or payment safeguard activities such as: 1) Medical review of claims to determine medical necessity and appropriate level of care 2) Deterring and detecting Medicare fraud 3) Auditing provider cost reports and ensuring Medicare pay the right amount when a beneficiary has other health insurance

question

Medicare Program Safeguard Contractors

answer

Under HIPAA, they will perform some/all of the activities already performed by Intermediaries and Carriers such as: 1) Review of provider activities 2) Cost report audits 3) Medicare secondary payer determinations 4) Provider and beneficiary education regarding program integrity 5) Developing and updating a list of durable medical equipment that is frequently unnecessarily utilized

question

Medicare Eligibility Requirements

answer

1) People aged 65+ 2) People of any age with End Stage Renal Disease 3) Certain disabled people under 65

question

Features of Medicare

answer

Most features are universally applied, but some variation exists from state to state for Medigap and Managed Care offerings

question

Medicare Claim Numbers

answer

Patient's or spouse's social security number with a letter/number prefix/suffix

question

Medicare Card

answer

Identifies if a patient has Medicare Part A and/or B and when the benefits became effective

question

Letter Code

answer

Tells how the patient acquired their Medicare benefits

question

A A (prefix) B C D D1 W W1

answer

Primary wage earner Retired railroad employee Entitled to benefits through spouse Child Widow Widower Disabled widow Disabled widower

question

Original Medicare Plan

answer

1) Traditional fee-for-service arrangement 2) Available everywhere in U.S. 3) Beneficiaries automatically eligible after 65th bday 4) Beneficiaries must apply 3 months before 65th bday

question

Parts of Medicare

answer

Part A - Hospital Insurance Part B - Medical Insurance Part C - Medicare Advantage Plan Part D - Prescription Drug Coverage

question

Medicare Part A

answer

Hospital insurance: 1) IP hospital services 2) Skilled nursing facility services (SNF) 3) Home health services 4) Hospice care

question

Medicare Part B

answer

Medical insurance: 1) Doctor services 2) OP hospital services 3) ER visits and ambulance transportation 3) Diagnostic tests 4) Lab services 5) Some preventative care (mammography, Pap smear screening) 6) OP therapy 7) Durable medical equipment and supplies 8) Home health services that Part A doesn't cover

question

Medicare Part C

answer

Medicare Advantage Plan; private insurance companies offering plans (mostly to seniors) such as HMOs and PPOs

question

Medicare Part D

answer

1) Medicare Prescription Drug Coverage 2) Helps lower prescription drug costs 2) Offers up to $3,600 for people with limited income to help pay for drug coverage

question

Medicare Carriers and Fiscal Intermediaries

answer

Private insurance organizations that handle claims and interpret reimbursement regulations under the Original Medicare Plan

question

Carriers

answer

Handle medical insurance (Part B) claims

question

Fiscal Intermediaries

answer

Handle all hospital insurance (Part A) claims

question

Medicare Covered Services

answer

Medicare (Part A) Hospital Insurance helps pay for necessary medical care and services in Medicare-certified hospitals, SNF, home health agencies, and hospices

question

Inpatient Hospital Care

answer

Medicare Part A helps pay for up to 90 days of IP care in each benefit period

question

Medicare (A) Inpatient Hospital Care Covered Services

answer

1) Semi-private room 2) Meals 3) General nursing services 4) Operating and recovery room costs 5) Intensive care 6) Drugs 7) Lab tests 8) X-rays 9) All other necessary medical services/supplies

question

Medicare's 3 Day (72 Hr) Rule

answer

1) Requires pre-admission testing and diagnostic services provided to a beneficiary by the admitting hospital within 3 days prior to admission are included in the IP payment 2) Not to be billed as separate OP charges unless no Part A coverage 3) Includes ER visits, but NOT ambulance services

question

Benefit Period

answer

1) Begins on first day of services in hospital or SNF 2) Ends 60 days after discharge if 60 days haven't been interrupted by skilled care elsewhere 3) No limit to number of periods 4) Beneficiary must pay IP hospital deductible for each period

question

Life Time Reserve Days (LRD)

answer

1) Medicare will pay for an additional 60 days of hospitalization when beneficiary is an IP for greater than 90 days 2) Only used once in a lifetime 3) For each day, Medicare pays all covered charges except for the daily co-insurance

question

Important Message from Medicare (IMM)

answer

Given to all IP Medicare beneficiaries, explains: 1) Rights as hospital patients (care and follow-up) 2) Advises what to do if patient feels he/she is being discharged too early and provides contact information for PRO 3) Hospitals CANNOT force patients to leave during case review

question

Skilled Nursing Facility Care (SNF)

answer

1) If medically necessary, Part A helps pay for up to 100 days in each benefit period 2) Medicare pays all approved charges for the first 20 days 3) Patients pay a co-insurance amount for days 21-100

question

SNF Covered Services

answer

1) Semi-private rooms 2) Meals 3) Skilled nursing services 4) Rehabilitation services 5) Drugs 6) Medical supplies

question

Home Health Care

answer

1) If medically necessary, Medicare pays the full approved cost including part-time or intermittent skilled nursing services prescribed by a physician for treatment or rehab of homebound patients 2) Patients only pay 20% coinsurance charge for medical equipment (wheelchair, walker)

question

Hospice Care

answer

1) Not covered by a Senior Medicare HMOs 2) Assists with care for terminally ill beneficiaries 3) No deductibles 4) Beneficiaries pay limited costs for drugs and IP respite care

question

Medicare Part B

answer

1) Pays 80% of approved charges for most covered services 2) Beneficiaries responsible for paying a $100 deductible per calendar year and remaining 20% of the Medicare approved charge 3) Limited additional charges

question

Limited Additional Charges

answer

1) Part B stipulation where patients pay 15% over Medicare's approved amount if their physician does not accept assignment 2) Only applies to certain services and does NOT apply to supplies or equipment

question

Yearly Medicare Enrollment Review

answer

1) November 15 - December 31 2) Medicare beneficiaries can enroll in a drug plan, review their health care and drug coverage, and make changes

question

Medicare

answer

Except for limited cases in Canada and Mexico, does not pay for coverage outside the U.S.

question

Medicare Part A (non-covered)

answer

Does NOT pay for: 1) Convenience items 2) Private rooms unless medically necessary 3) Nursing home care except SNF for rehabilitation 4) Custodial services (daily living activities)

question

Medicare Part B (non-covered)

answer

Does NOT pay for: 1) Most prescription drugs 2) Routine physical exams or services not related to injury or illness 3) Dental care or dentures 4) Cosmetic surgery 5) Routine foot care 6) Hearing aids 7) Eye exams or glasses

question

Advance Beneficiary Notice (ABN)

answer

1) Should be given to a Medicare beneficiary if Medicare may not consider services medically necessary and there's a chance Medicare won't pay 2) If not signed before service, patient can't be held responsible for bill

question

Fiscal Intermediaries

answer

Use software that compares the diagnosis (ICD9 code) to the service (CPT code) to determine medical necessity

question

Medicare as Secondary Payer (MSP)

answer

1) Another insurance is primary and Medicare is secondary 2) Other insurance (excluding Medigap) that must pay before Medicare 3) Questionnaire should be completed on all Medicare patients each time a service is rendered

question

Medicare as Secondary Payer requirements

answer

1) Patient is 65+ with group health insurance through they or their spouse's current employer with 20+ employees 2) Patient is under 65 and disabled, and they or any family member is covered by group health insurance through a current employer with 100+ employees 3) Patient has Medicare due to permanent kidney failure (ESRD) 4) Patient has illness/injury covered under workers' compensation, the federal black lung program, no-fault insurance, or liability insurance

question

Retirement Date Before Medicare Entitlement

answer

Entitlement date used as the retirement date

question

Retirement Date Post Medicare Part A Entitlement

answer

If it has been at least 5 years since retirement, enter a date of 5 years back from the date of service as the retirement date

question

ICD9 Codes

answer

Diagnosis codes

question

CPT Codes

answer

Current Procedural Terminology codes used for coding procedures

question

Recurring visits

answer

1) One account is created and the patient has several visits for the same service and all charges are entered into the one account (Ex. physical therapy) 2) Verify patient's MSP info every 90 days

question

Diagnostic Related Grouping (DRG) rate

answer

1) Avoids excessive IP stays 2) Medicare pays fixed amounts to hospitals according to the patient's diagnosis, regardless of charges or length of stay 3) Determines base payments hospitals will receive comprised of a standardized amount

question

Add-Ons

answer

Medicare pays higher amount based upon DRG if hospital services many low-income patients or is an approved teaching hospital

question

Medicare Payment

answer

Based on coded diagnoses and procedures and rarely influenced by total charges

question

Ambulatory Payment Classifications (APCs)

answer

1) Medicare payments of professional services and most hospital outpatient services 2) Tied to CPT codes 3) Payment rate established for each 4) Calculated based on the national average cost (operating and capital) of the hospital

question

Ambulatory Payment Classifications

answer

1) Amount the patient is responsible for will vary until the amount can be set at a standard 20% of the payment 2) Gradually phasing of payment to prevent patients from being hit with large co-pays 3) Medicare placed a cap on the max amount a patient is responsible for 4) Patient liability will not exceed the IP deductible amount for each OP service

question

Fee Schedule

answer

How Medicare pays for outpatient services like Lab and Physical Therapy

question

Supplemental Insurance

answer

Types of private health insurance that pay some or all of healthcare costs not covered by Medicare 1) Employee coverage 2) Retiree coverage 3) Medigap coverage

question

Medigap

answer

1) Medicare supplemental insurance 2) Private insurance designed to help pay Medicare cost-sharing amounts such as Medicare's co-insurance, deductibles, and uncovered services 3) Must follow federal and state laws 4) Must be 1 of 10 standardized policies to make comparison easy 5) Unnecessary for patients covered by Medicaid or in Medicare Managed Care plans 6) Illegal for insurance companies to sell plans to these beneficiaries

question

Medicare SELECT

answer

1) Type of Medicare supplemental health insurance sold by insurance companies and HMOs 2) Similar to standard Medigap insurance 3) Each insurer has specific hospitals, and sometimes doctors, they are required to use in order to be eligible. 4) Lower policy premiums than Medigap due to specificity

question

Medicare Beneficiary Noties (MBN)

answer

1) Monthly statement that clearly lists claims info 2) Replaces Explanation of Your Medicare Part B Benefits (EOMB), the Medicare Benefits Notice (Part A), and benefit denial letters

question

Medicare+Choice Plan

answer

Provides care under contract to Medicare 1) Medicare managed care plans like HMOs 2) Medicare Private Fee-for-Service plans

question

Medicare+Choice plan

answer

1) Medicare pays a set amount of money for your care every month to these private health plans 2) In return, the plan manages the Medicare coverage for its members

question

Medicare+Choice Plan members

answer

1) Still in the Medicare program 2) Must have Medicare Part A and B, and continue to pay Part B premium 3) Still gets regular Medicare-covered services and may be able to get extra benefits like prescription drugs or additional hospital days 4) May get benefits like coordination of care or reduced out-of-pocked expenses

question

Private Fee-for-Service

answer

The private company (not Medicare) decides how much it pays and the patient pays for outlined services

question

Private Fee-for-Service stipulations

answer

1) Patients can go to any Dr. or hospital that accepts the terms of the plan's payment 2) Provides coverage to people with Medicare who join this plan 3) Private company pays a fee for each Dr. visit/service, patient may also have a copay 4) "Pre-notification" requirement 5) Patients may pay more if the plan lets Drs, hospitals, and other providers bill more than the plan pays; may be a limit; patients must pay difference

question

Pre-Notification Requirement

answer

Requires patient notify insurance carrier about any "elective" IP hospital admissions

question

Alternative healthcare choices offered by Medicare

answer

**Dependent upon where the beneficiary lives **Beneficiaries still in the Medicare program ** Must provide basic Medicare covered services Medicare Managed Care Plans Preferred Provider Organizations (PPO) Provider Sponsored Organizations (PSO) Private Fee-for-Service Plans Medicare Medical Savings Account Plans

question

Eligibility Requirements for Alternative Medicare Health Plans

answer

1) Have both Part A and Part B 2) Continue to pay the monthly Part B premium 3) Live in the plan's service area (counties where plan is offered) 4) Not have End Stage Renal Disease (ESRD)

question

Medicare HMO Plans

answer

Follow MSP rules for auto accidents, work-related accidents, and the working aged Ex. If a patient with this plan has services related to an auto accident, the auto insurance MUST be billed primary

question

Medicaid

answer

1) Established by federal legislation in 1965 to provide basic health care coverage for certain low-income people 2) Funded and administered through state-federal partnership 3) States have a wide-degree of flexibility to design their program 3) Secondary to Medicare

question

State Authorities for Medicaid

answer

1) Establish eligibility standards 2) Determine what benefits and services to cover 3) Set payment rates

question

Medicaid Qualifications

answer

1) Certain low-income families with children 2) Aged, disabled, or blind people on Supplemental Security Income 3) Certain low-income pregnant women and children 4) Certain persons with catastrophic medical expenses who would not otherwise qualify

question

Basic Services Covered by Medicaid

answer

All states must cover: 1) IP and OP hospital services 2) Lab and X-ray 3) Skilled nursing and home health 4) Dr. services 5) Family planning 6) Periodic health check-ups, diagnosis, and treatment for children

question

Medicaid

answer

Apply at local welfare or social service offices; many states may allow applying at alternate locations

question

Traditional Medicaid

answer

1) Participant's financial status evaluated on a regular basis 2) Each Medicaid recipient will have his/her own recipient ID number

question

Traditional Medicaid Card

answer

1) In many states, new card is issued each month 2) Eligible dates appear on card 3) Issued to the head of the family 4) Lists names and recipient ID numbers

question

HMO Medicaid

answer

1) Contracts and billing requirements determined by the State 2) Healthcare organizations contract with this organization to provide services to Medicaid recipients 3) Claims are submitted directly to and paid by organization, which is then reimbursed by Medicaid

question

Workers Compensation

answer

Services resulting of a work related accident/injury that are paid for by the patient's employer or the employer's workers compensation insurance company

question

Workers Compensation

answer

1) Employer must authorize services 2) No card

question

Billing Requirements for Workers Compensation

answer

1) Claim number 2) Name of person authorizing services 3) Patient's social security number

question

Key Information for Workers Compensation

answer

1) Time and date of injury 2) Type of injury 3) Name of employer and contact person 4) Immediate supervisor 5) Employee insurance info (in case injury deemed not work related) 6) Enter patient classification type as "Workers Compensation" and who should receive the bill

question

Auto Insurance

answer

1) Coverage for injuries resulting from an auto accident 2) Primacy between Auto and Health insurance determined by state regulations 3) Usually primary for all victims of an auto accident 4) Obtain claim number, billing address, and adjuster's name/phone number 5) Verify benefits

question

Auto Insurance = Primary

answer

1) Patient has no health insurance 2) Medicare or Medicaid as primary and services result from an auto accident

question

Liability Coverage

answer

1) For injuries that are the result of negligence of another party 2) Healthcare facilities have their own policies 3) MSP questionnaire identifies liability for Medicare patients 4) Medicare will pay if coverage is denied and decision does not change in the future 5) No insurance card

question

Commercial Insurance

answer

1) Insurance monitored by state insurance commissions that does to require a specific contract with a provider organization to reimburse for patient services 2) Patients not required to select a PCP or go to a specific provider

question

Commercial Insurances

answer

Workers Compensation, Blue Cross, Auto, PPO, HMO NOT: Medicare, Medicaid, Federal, State or County Programs

question

Commercial Insurance Cards

answer

1) ID number 2) Group number 3) May or may not be an effective date 4) Policyholder's social security number may be required for billing

question

Preferred Provider Organizations (PPOs)

answer

1) Contracts between employers, doctors, and hospitals where the doctors and hospitals agree to provide discounted services for a volume of members in return 2) Members are not required to select a PCP but must use a participating provider for full coverage

question

Participating Providers

answer

Doctors/hospitals participating in PPOs

question

PPO Cards

answer

1) Many different cards 2) ID number 3) Effective date 4) Co-pay amounts for ER/UC and office visits 5) May or may not have a group number

question

Health Maintenance Organizations (HMO)

answer

Insurance plans that strive to control healthcare costs by requiring members to receive services as designated facilities; members must select a PCP; contracts with specific providers/facilities

question

Tricare

answer

Overseen by the Department of Defense in cooperation with regional civilian contractors; secondary payer to coverage from another health plan (HMO/PPO); primary if other coverage is Medicaid or Indian Health Service

question

Tricare Prime

answer

Tricare similar to HMO; active duty service members automatically enrolled

question

CHAMPVA

answer

Civilian Health Medical Program for the Veterans Administration; for families of veterans with 100% service connected disability and the surviving spouse or children of a veteran who dies from a service connected disability; eligibility determined by Department of Veterans Affairs

question

Tricare Extra

answer

Tricare PPO that saves money for patients

question

Tricare Standard

answer

Tricare Fee-for-Service option, same as former CHAMPUS; shares the cost of most medical services from civilian providers even beneficiaries cannot get care from a military hospital/clinic

question

Tricare for Life

answer

Tricare expanded medical coverage for Medicare-eligible beneficiaries; must have Medicare Part B; patient received all benefits under Original Medicare Plan; Medicare pays first

question

Military Treatment Facilities (MTFs)

answer

Primary source of healthcare for active duty service members

question

Common Working File

answer

Verification system linked to Medicare

question

Carve Out

answer

Decision to desperately purchase a service which is typically part of an HMO plan

question

Coordination of Benefits (COB)

answer

Determining the order in which benefits are paid and the amounts that are payable when a patient is covered by multiple health plans

question

National Association of Insurance Commissioners (NAIC)

answer

Standardized the coordination of benefit rules

question

Birthday Rule

answer

Determines which parents plan will be primary when dependents are on both parents' health plan; the plan of the parent whose birthday occurs earlier in the year is primary

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