To get the most out of their health insurance, many couples with two incomes put their children on both plans. But if there wasn't some way for health insurance companies to coordinate benefits, it's possible that you or your doctor would be reimbursed for more than the actual cost of your claim.
Health insurance companies usually make one parent's plan the primary plan and the other parent's plan the secondary plan to avoid this. (That's why your doctor's office asks you to fill out a form about your primary and secondary coverage.) The primary plan is in charge of paying for covered costs up to the policy's limits. The secondary coverage kicks in if there are still costs that haven't been paid.
WHICH HEALTH INSURANCE COVERAGE YOU HAVE DEPENDS ON YOUR DATE OF BIRTH.
People often use the birthday rule to figure out which plan is more important. Under this rule, the primary plan is the one of the parent whose birthday comes first in the calendar year. It doesn't matter who is older because what matters is the date of birth, not the year.
Like most rules, there are exceptions to the birthday rule:
- If both parents have the same birthday, the child's main coverage comes from the parent who has been on his or her plan the longest.
- If one spouse is currently working and has health insurance through their current employer, and the other spouse has health insurance through a former employer, the plan of the spouse who is currently working would be the most important.
- If a couple gets divorced or splits up, the plan of the parent who has custody is usually the main source of coverage. If the parent who has custody gets remarried, the new spouse's coverage becomes less important. And finally, the health insurance plan of the parent who doesn't have custody would add a third layer of protection. This order of payment can be changed by a divorce decree or agreement, but the health insurance companies must be told.
THESE RULES ARE NOT THE LAW. THEY ARE JUST FOR HEALTH INSURANCE.
Keep in mind that health insurance companies often do these things, but they are not against the law. Different insurers may have different ways of doing things. Carefully read your policy to make sure you know how your insurance company handles having two plans. If you don't understand what your policy covers, ask your employer's benefits specialist or the customer service department of your insurance company for help.
