The 'insurance with other insurers' provision states an insurer can pay benefits on a pro-rata basis if what condition is met?

• A. Notification was given to the insurer prior to the claim that the insured has other health coverage
• B. No notification was given to the insurer prior to the claim that the insured has other health coverage
• C. The claim is filed after the policy term ends
• D. The insured declines to provide information about other coverage

Answer: (B)

When multiple insurances are involved, benefits are coordinated so you don’t receive more than the total cost of care. The key point here is notice. If there is other health coverage and the insurer is not told about it before the claim is filed, the insurer may pay benefits on a pro-rata basis. That means the payment you receive from this policy is reduced to a share that reflects the presence of the other coverage, preventing duplication of benefits.

For example, if there’s another policy that would cover half the bill, and this policy isn’t informed before the claim, this policy might pay only its portion corresponding to the total available coverage, rather than paying the full amount. If you do notify the insurer about other coverage before filing, the plans coordinate so each pays its fair share rather than applying a pro-rata reduction due to lack of notice.

The other options don’t capture the triggering condition for pro-rata as stated: notification before the claim in the absence of which benefits are pro-rated.