Health Insurance: Frequently asked questions

I am divorced and have two children. Can they be covered under my health plan and my husband's health plan at the same time? And how do we determine which health plan pays for their medical claims?

Children — and even adults — can often be covered under more than one health plan, and it's common for divorced parents to include their children on each health plan in order to maximize their benefits.

When you're covered under multiple health plans, they'll have to coordinate your benefits, so that they aren't both paying for the same claims. You generally cannot come out ahead by having each plan reimburse you so that the total they pay is more than 100 percent of the cost of your medical claim; they don't want you pocketing extra money.

For children who are covered under each parent's group health plan, one plan is considered "primary" and the other is considered "secondary." The plan that is primary pays the cost of the claims first. The secondary plan pays any remaining costs not covered by the primary plan — as long as the medical care is actually a covered benefit under the secondary plan. It won't reimburse you for services that aren't covered.

How do you know which plan is primary and which is secondary?

The health insurance industry uses an informal practice called the "birthday rule." Under the birthday rule, the health plan of the parent whose birthday comes first in the calendar year is designated as the primary plan. Note that it doesn't matter which parent is older, since the year of birth is not a factor. Thus, if your birthday is July 15, 1955, and your ex-spouse's is Sept. 17, 1953, your health plan would be considered primary because your birthday comes first in the calendar year. For more, read "Birthday rule" determines whose health plan covers your kids.

If you and your ex-spouse have different types of health plans, the rules are also different. If you have a group health plan and your ex has an individual plan, the group plan pays first, regardless of the birthday rule. And in some cases, the divorce court stipulates how your children will be covered.

For more details, read How divorce affects your health insurance.

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