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Primary Health Insurance

With all of the talk about the breakdown of the health care system in America, there are still some families who are very lucky. They are the families that have more than one health plan covering them. This is usually the case when both spouses work and choose to cover the family under group health insurance plans from their employers. But it can get tricky figuring out which insurance plan is primary and which one is secondary.

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Primary health insurance vs. secondary health insurance

Let's start with the easy scenario: Each spouse has primary insurance under his or her own health insurance plan and secondary insurance under the spouse's plan. When you add children into the mix, you can elect which parent's policy will be primary.

One method insurers use to determine the primary plan is by finding out which spouse has the earlier birth month. If you get to elect the primary plan yourself, you'll usually make the determination based on cost, what is and is not covered, and the co-payment amount. The other policy becomes secondary.

In the case that the parents become divorced, the divorce decree will likely specify which parent must carry primary medical insurance on the children.

How are benefits paid with primary and secondary health insurance?

Every health insurance plan explains how benefits are coordinated between a primary and secondary plan. It's possible that your unpaid costs from a primary plan can be automatically rolled into the secondary plan.  Generally, however, after your primary coverage has paid benefits, you  will need to submit the unpaid portion to the secondary insurer to determine if the costs will be covered. Remember: Co-payments and deductibles will still have to be paid out of your pocket. The fact that you have two health insurance plans won't change that!

Whether you're in the market for primary health insurance or secondary health insurance, we can help!

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