Health Insurance Rules
Posted by admin on May.21, 2013, under Health Insurance
Many dual income couples, include their kids on every group health insurance plan to maximize benfits. Nevertheless, 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 become reimbursed for a lot more than 100 percent from the actual cost of the claim.
To prevent this, health insurance providers typically designate one parent’s health insurance strategy because the main strategy 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 strategy is responsible for paying covered expenses as much as the limits from the policy. If any unpaid expenses are left over, the secondary coverage kicks in.
THE DATE OF BIRTH DETERMINES WHICH HEALTH INSURANCE PROVIDES COVERAGE
The birthday rule is actually often used to figure out which strategy is primary and which is secondary. Under this particular rule, the plan of the parent whose birthday occurs first in the calendar year is actually designated as primary. The date of birth is the identifying factor not the year so it doesn’t matter which spouse is actually older.
Like most rules, the birthday rule has exceptions:
- If both parents share the same birthday, the parent who has been covered by his / her plan longest provides the primary coverage for the children.
- If one spouse is actually currently employed and has health insurance through a current company, and the other partner has coverage through a former company, the plan belonging to the curently employed partner would be primary.
- In the event of separation and divorce or seperation, the plan from 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 offer a third layer of insurance protection. This purchase of payment can be altered by a court issued separation and divorce decree or by contract, but the health insurance providers must be notified.
They are JUST HEALTH INSURANCE RULES NOT THE LAW
Maintain in mind that these practices are common among health insurance providers, however they are not governed by law. Practices may vary through one insurer to another. Read your policy carefully to ensure you understand how your insurance company handles dual coverage. If the policy coverage is unclear, request for help from your employers benefit specialist or your insurer’s client service department.
