When an employee has two different insurance plans at the same time, they have dual coverage. One plan will be designated as the primary plan and will pay first, the other will be designated as the secondary plan and will pay second.
- Certain carriers have a policy where any plan without a Coordination of Benefits provision always pays first.
- If the person receiving benefits is the participant under the contract (the policyholder), that health plan will be primary. The spouse’s health plan will become secondary.
- If a dependent child is covered under two or more plans, the child's primary plan will be the one that belongs to the member whose birthday occurs earlier in the calendar year. This is known as the birthday rule. However, two exceptions to this rule exist:
- If both members have the same birthday, the policy that has been in effect longer will be primary.
- The birthday rule is overruled when a court order or custody rule applies.
Primary/secondary plan status is established by the carrier and cannot be determined by the employee.
This is useful in the event that the insured receives services, they can submit both lines of coverage and there's the possibility that one carrier will cover what the other carrier does not.
For more information on coordination of benefits with Medicare, see medicare.gov.
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