How to Determine Primary & Secondary Health Insurance Coverage

Having health insurance coverage from a primary and secondary source can reduce or eliminate out of pocket health expenses. Health insurance providers have special rules for families with two or more health insurance policies to follow. According to the Hepatitis C Support Project (HCSP), the rules began in the 1950s when it became more common for both spouses to work outside the home. The Employee Retirement Income Security Act of 1974 initiated a birthday rule to determine primary health insurance coverage for a child with two working parents. Of course, exceptions to the birthday rule make determining primary and secondary health insurance coverage a little more complicated.

Things You'll Need

• Birthdays of insurance policyholders
• Custody agreement/Court orders
• Length of employment of policyholders
• Current employment status of policyholders
• Type of insurance coverage (group, individual, Medicaid, VA)

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Instructions

• 1

  Charge your healthcare expenses to your health insurance policy. Your insurance is the primary coverage for you. Your spouse's health insurance coverage is primary for your spouse. However, if your insurance coverage is through Medicaid or VA, and your spouse has health insurance coverage through an employer, then your spouse's policy is primary for you as well.

• 2

  Determine whose birthday comes first when you have two married people with dependents. The child's doctor will bill the primary health insurance provider of the parent whose birthday falls first in a calendar year. For example, one parent's birthday is January 21, and the other parent's birthday is October 14. The January 21 birthday is the primary coverage.

• 3

  Bill health care costs to the custodial parent's insurance policy first, when parents are divorced or legally separated. This is a general rule unless court documents specify which parent has primary responsibility for health insurance coverage.

• 4

  Consider which parent has insurance under a current employer if one is retired. Consider which person has been with the same employer the longest when both birthdays fall on the same day. Coverage under a current employer is primary over COBRA insurance coverage. Otherwise, the coverage that started first is the primary insurance coverage when birthdays are the same.

• 5

  Send insurance claims to group health providers first. Group insurance coverage is primary over individual plans, Medicaid, and VA coverage.