Many dual income couples,
include their children on each group health
insurance plan to maximize benfits. However, without
some sort of system in place to help the health
insurance companies coordinate benefits, it's
possible that either you or your doctor would be
reimbursed for more than 100 percent of the actual
cost of your claim.
To prevent this, health insurance companies
typically designate one parent's health insurance
plan as the primary plan and the other as the
secondary plan. (That's why the patient
questionnaire at your doctor's office asks for
information on primary and secondary coverage.) The
primary plan is responsible for paying covered
expenses up to the limits of the policy. If any
unpaid costs are left over, the secondary coverage
kicks in.
THE DATE OF BIRTH DETERMINES WHICH HEALTH
INSURANCE PROVIDES COVERAGE
The birthday rule is often used to determine
which plan is primary and which is secondary. Under
this rule, the plan of the parent whose birthday
occurs first in the calendar year is designated as
primary. The date of birth is the determining factor
not the year so it doesn't matter which spouse is
older.
Like most rules, the birthday rule has
exceptions:
- If both parents share the same birthday, the
parent who has been covered by his or her plan
longest provides the primary coverage for the
children.
- If one spouse is currently employed and has
health insurance through a current employer, and the
other spouse has coverage through a former employer,
the plan belonging to the curently employed spouse
would be primary.
- In the event of divorce or seperation, the plan
of the parent with custody generally provides
primary coverage. If the custodial parent remarries,
the new new spouse's coverage becomes secondary. And
finally, the non custodial parent's health insurance
plan would provide a third layer of insurance
protection. This order of payment can be altered by
a court issued divorce decree or by agreement, but
the health insurance companies must be notified.
THESE ARE JUST HEALTH INSURANCE RULES NOT THE LAW
Keep in mind that these practices are common
among health insurance companies, but they are not
governed by law. Practices may vary from one insurer
to another. Read your policy carefully to make sure
you understand how your insurance company handles
dual coverage. If the policy coverage is unclear,
ask for help from your employers benefit specialist
or your insurer's customer service department.
