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Ask the Health Insurance Expert

If my son has dual health insurance coverage, can I use each insurance policy separately? Can I use the secondary insurance to pay for certain medical expenses without mentioning the primary insurance to the doctor?

No, you need to let health care providers know about both health insurance plans, so payments can be coordinated. Most likely the plans will ask if you have other coverage. They want to make sure you or your health care provider are not reimbursed for more than 100 percent of the cost of treatment.

When children are covered under multiple health insurance plans, one plan is considered the primary plan, and the other is considered the secondary plan. The primary plan pays out first, and then the secondary plan pays any remaining costs, as long as the treatment is a covered benefit under the secondary plan. Using both plans can help you maximize benefits.

To determine which plan is primary, the health insurance industry widely adopted something known as the "birthday rule." Under this informal procedure, the health plan of the parent whose birthday comes first in the calendar year is designated as the primary plan. The year of birth doesn't matter--only where the date falls during the year.

There are exceptions to the birthday rule. When parents are divorced or separated, the plan of the parent who has custody pays first, and the plan of the parent who doesn't have custody pays second.

Often both divorced parents list their children on each of their health plans, especially if a former spouse lives in a different city. A plan's health provider network is usually restricted to a local area, so coverage in both parents' locations is important.

For more, see 'birthday rule' determines health insurance coverage.



Last updated: May. 26, 2011