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What Is Primary Health Insurance?

If you've got more than one health insurance plan, you'll need to know which one is your primary health insurance and which one is your secondary health insurance. This is so the insurance companies know which carrier is going to pay the majority of the benefits to which you're entitled. In some cases, there can even be a third carrier.

  1. Primary

    • Primary health insurance is the insurance that pays out first when you need to use it. When you first fill out an application for health insurance, you're asked if you have other coverage. The reasons behind this are to prevent too much money from being paid out when the insurance is used.

    Birthday Rule

    • The birthday rule, while not set in stone, has been widely used by the health insurance industry to determine how benefits will be paid out when a dependent child is covered under two parents' health plans. These plans are usually under a group umbrella. The birthday rule has the parent who has the birthday coming first in a calendar year as being the primary health insurance provider. There are exceptions to this rule, including the question of what happens if both parents have the same birthday. That being the case, the parent who has had the longer coverage period is going to be the primary health insurance. It's important to note that the birthday rule is not an industry law and to find out how an individual health coverage plan works, you need to check your own policy paperwork and talk to your insurance agent.

    Medicare

    • When you first are eligible for Medicare, you'll be sent a form that needs to be filled out and returned. On it, you'll be asked about your current health insurance coverage and you'll need to tell them about any other insurance polices that you might have. In some cases, the policy you're currently under will be your primary health insurance and Medicare will be your secondary insurance. Depending upon the situation, Medicare may care first or your other insurer might.

    VHA

    • The Veterans Health Administration buys and delivers health coverage to veterans and their dependents. You can have VA coverage as your primary health insurance and also have secondary health insurance. The level of coverage that you can receive from the VHA is determined by the level you've been assigned by the VHA. Levels range from P1 through P8 and are determined by factors such as disabilities that are service-related, your income level and what other insurance policies you might have. In order to determine whether or not your primary health insurance is the VHA policy, you need to speak with a VHA representative.

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