Primary vs. secondary coverage: What to do when you have two health plans
Axis Capital Group Insurance Review
According to the Gallup-Healthways Well-Being Index as of February 2014, even with the Affordable Care Act, which mandates that practically all Americans have health insurance, 15.9 percent of Americans lack coverage.
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Imagine being a person with not just one but then two health plans, may sometimes sound like a fraud.
Possessing two health plans doesn’t mean you get reimbursed twofold instead of one.
So who pays first? “The place you are employed is primary,” explains Matt Tassey, past chairman of the LIFE Foundation, now called Life Happens.
Therefore, if you’re still covered under your parents’ plan and have group health at work, your workplace plan is chief. If you’re covered under your partner’s plan and one at your work, your workplace plan is main plan.
“The secondary plan pays any unpaid balance,” says Tassey. “It will not pay the deductible of the primary plan.”
These rules are known as “coordination of benefits.” The rules for adults shouldn’t be confused with the rules for children who are dependents on two parents’ group health plans. In the case of children with double health insurance coverage, the "birthday rule" applies. This practice says that the group plan of the parent with the first birthday in the calendar year is primary.