Federal Laws and Regulations Regarding Primary Insurance of Minors in Pennsylvania

If the parents of insured Pennsylvania minors are married, there is one set of rules that cover the selection of the primary and secondary health insurance policy. However, those same rules don't apply if the parents are divorced or based on the type of plan each spouse has. In most cases, this is common practice but not the law. However, there is federal law regarding primary and secondary insurance for children eligible for Medicare.

Birthday Rule

• In Pennsylvania, if both parents have medical insurance coverage for a minor child, the person with the birthday earliest in the year supplies the primary insurance for the child; and the other spouse, born later in the year, supplies the secondary insurance. This doesn't mean the oldest person is the primary insurance carrier. If Mrs. Smith was born January 1, 1979, and Mr. Smith was born May 31, 1967, Mrs. Smith would be the primary carrier since her birthday came first in the calendar year. This is a customary practice.

Divorced or Separated Parents

• Divorced or separated parents have a different set of rules. If one parent were the custodial parent, his insurance would be primary. However, a divorce decree can change that. The decree names the parent who must provide coverage and often notes who the primary insurance provider is. If the custodial parent or primary provider parent remarries and the new spouse provides insurance, the new spouse's insurance is the primary insurance coverage.

Divorced With Different Types of Plans

• If one divorced or separated parent has a private insurance policy and the other has a group policy, the customary practice in Pennsylvania is to consider the group policy primary. The individual private insurance policy is secondary insurance for the minor.

COBRA or Active Employee

• When parents of the minor are divorced or separated and one of them recently left a job, it also make a difference. If the parent has the child covered on COBRA, for employees no longer working, and the other carries group insurance through active employment, the one actively working has the primary insurance.

Federal Law and Medicare

• There are federal regulations regarding children receiving Medicare. While Medicare is normally for seniors over the age of 65, children with end stage renal disease or disabilities can also receive Medicare. If you provide health insurance coverage, you must use the services of a Coordination of Benefits -- COB -- Contractor. Medicare is always the secondary insurance coverage.