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District

Primary vs Secondary Coverage

If you have more than one health insurance, it is crucial that you familiarize yourself with Primary vs Secondary coverage so that you know how your insurance should be processed. The below guidelines should always be followed to prevent double-dipping. (For example; if a claim is submitted and honored by the secondary coverage, they may be overpaying as the primary coverage should have been submitted to first.) Please note, if this happens, insurance companies will recoup the lost funds by any means, including billing you. To ensure this type of error does not happen, please follow the guidelines below.

  

Which policy is primary is dictated by law and the agreement with the insurance companies.

 

Here are the general rules of the National Association of Health Insurance Commissioners. These rules are listed in order - the first one to apply to you will be used to process claims.

1. If the Policy Holder is the same for both contracts:
a. The plan that covers the policyholder
 as an active employee is primary.
b. If the policyholder has the same employment status (active/retired) under both plans, the plan with the earliest effective date is primary.

2. If the Policy Holder is the spouse or domestic partner:
a. The plan that covers the policyholder as an employee is primary. The spouse's is secondary.

3. If children are covered under more than one policy and the parents are married or living together:
a. The policy of the parent whose birthday (month and day) is earlier in the year is primary.
b. If the parents share the same birthday (month and day), the policy with the earlier effective date is primary.

4. If children are covered under more than one policy and the parents are divorced or living apart:
a. The policy of the parent that the court has made responsible for health care insurance is primary.
b. The policy of the parent who has custody of the children is primary.
c. If the court has not placed responsibility on one parent to insure the children and the parents have joint custody, the policy of the parent whose birthday (month and day) is earlier in the year is primary. If the parents share the same birthday (month and day), the policy with the earlier effective date is primary.
d. If the natural parent elects to have coverage under the policy of the step parent, we will consider the policy to be that of the natural parent.