Both husband and wife have group health insurance through their employers. Each spouse is covered under both policies. Under the coordination of benefits provision, how will the benefits be paid if the wife incurs a covered loss?

This option incorrectly suggests that both insurers will split the payment equally, which is not how coordination of benefits typically functions. Instead, one policy is designated as primary, and it pays first, while the secondary insurer covers the remaining balance, if applicable.

While this statement resembles the correct process, it fails to clarify that the insurer paying second is the designated secondary insurer, not necessarily the wife’s insurer. The primary and secondary designations depend on the specific rules of each insurance plan and not simply on whose policy is used first.

This choice inaccurately implies that the secondary insurer has no role in covering the loss. While it is true that the primary insurer pays first, the secondary insurer can cover any remaining costs, subject to its own policy limits and provisions, making this statement incomplete.