Primary vs. secondary coverage: What to do when you have two health plans

According to the Gallup-Healthways Well-Being Index as of February 2014, even with the Affordable Care Act, which mandates that practically all Americans have health insurance, 15.9 percent of Americans lack coverage,Axis Capital, a group of companies with branch offices in Bermuda, Australia, Canada, Europe, Latin America, Singapore and the United States and has been also servicing SE countries such as KL Malaysia, Bangkok Thailand, Jakarta Indonesia and many more,

Imagine being a person with not just one but then two health plans, may sometimes sound like a fraud.

This double coverage can take place in many ways:

• An adult child may be covered under a parent’s plan, which must be permissible until age 26, and likewise has a job with workplace advantages.

• An employee may take his or her company’s health plan and likewise be enrolled under a spouse’s plan at the spouse’s workplace.
• Simply, a scam!

Possessing two health plans doesn’t mean you get reimbursed twofold instead of one.

Warning! There are a few disadvantages to what, on the surface, appears like health insurance heaven:

• Double coverage frequently means you’re paying for redundant coverage.
• You need to make your claim with your “primary” plan first. The additional plan can pick up the tab for whatsoever not covered, but it won’t pay something heading the primary plan’s deductible.
• If both plans have deductibles, you’ll have to fee both before coverage kicks in.

• You don’t get to select which health plan is primary, signifying the one that pays first. You don’t get to pick which insurer will pay a definite claim. On the other hand, if the first insurer doesn’t cover a particular treatment, or covers it only moderately, you can then submit the rest of the claim to your secondary insurer for payment, supposing the treatment is covered under the second plan.


So who pays first? “The place you are employed is primary,” explains Matt Tassey, past chairman of the LIFE Foundation, now called Life Happens.

Therefore, if you’re still covered under your parents’ plan and have group health at work, your workplace plan is chief. If you’re covered under your partner’s plan and one at your work, your workplace plan is main plan.

“The secondary plan pays any unpaid balance,” says Tassey. “It will not pay the deductible of the primary plan.”

These rules are known as “coordination of benefits.” The rules for adults shouldn’t be confused with the rules for children who are dependents on two parents’ group health plans. In the case of children with double health insurance coverage, the “birthday rule” applies. This practice says that the group plan of the parent with the first birthday in the calendar year is primary.


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