Problems Related to Secondary Health Insurance
Part 2, Chapter 4: Traditional Individual and Group Plans, Doctors' Bills Page 15
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Secondary insurance may be available whenever two individuals in a family each have separate health insurance policies that provide for family coverage. The process of determining such benefits is often referred to as the coordination-of-benefits system. Secondary insurance benefits may provide a significant amount of reimbursement -- particularly for families with high medical bills -- and can thus be important from an economic point of view.
However, there are a number of problems that may occur when dealing with secondary coverage. One of the most common problems has to do with trying to determine which insurance policy is primary and which is secondary, particularly when the claim is for a child. That determination is important, since claims must be sent first to the child's primary insurer. Once the primary insurer has paid its portion of the bill, the claim can be submitted to the secondary insurer.
Until a few years ago, it was often assumed that a father's health insurance policy represented a child's primary insurer. However, these days, if both parents have health insurance policies that provide for family coverage, the primary status is often assigned to the parent whose birth date comes earlier in the year.
Thus, if a child's mother was born in September, and the child's father was born in October, the mother's insurance policy would generally be considered the child's primary insurer and the father's policy would be considered the secondary insurer. The determination of which parent's insurance policy is primary for a child in a situation in which both parents have health insurance with family coverage generally depends only on the month and date of the parents' birth, not on the year in which the parents were born. Check with your insurance company to review their system for determining the primary insurer in such situations.
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