Health Insurance Rules

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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 companies coordinate health insurance benefits, it may be that you or your doctor will be restored to more than 100 percent of the actual cost of your claim.
Health insurance rules

To prevent this, health insurance companies typically designate one parent's health insurance plan as the primary plan and the other as a secondary plan. (That's why the patient questionnaire at your doctor's office asking for information about primary and secondary coverage.) The main plan is responsible for paying the cost of covered until the policy limits. If the fee is paid remaining, secondary coverage kicks.


Birthday rule is often used to determine the primary message and which is secondary. Under this rule, the master plan re-occurring in the first calendar year is set as the primary. Date of birth is not the determining factor in so it does not matter an older couple.

Like most rules, the birthday rule has an exception:

-If Both parents share the same birthday, parents who have been covered by the longest of its plan to provide primary coverage for children.

-If One pair is currently used and have health insurance through a current employer, and the other spouse has coverage through a former employer, the couple plan at work would be major.

-In The case of divorce or separation, master plan with custody generally provides primary coverage. If the custodial parent remarries along, new partner new coverage becomes secondary. And finally, parents are free Custodian health insurance plan will provide a third layer of insurance protection. This sequence of payments can be changed by a court issued divorce decree or by agreement, but the health insurance company should be notified.


Keep in mind that these practices are common among health insurance companies, but they are not regulated by law. Practice may differ from one insurance company to another. Read your policy carefully to make sure that you understand how your insurance company handles dual coverage. If the scope of the policy is not clear, ask for help from your employer benefit specialists or customer service department of your insurance company.