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Can We Be Covered Under Two Different Health Insurance Plans?

By Megg Mueller on May 24th, 2010

Health Insurance

Dual insurance coverage is fairly common today as many families have two parents who work and receive health insurance coverage from employers. But if both you and your partner have group health insurance, can you cover one another under your own plan as well? What about the kids? Can they be covered under both insurance plans? Absolutely, as long as you understand the rules.

Coordination of benefits

For married couples, each person's plan remains responsible for primary coverage, while the spouse's coverage is considered the secondary plan. Determining which plan pays for what is called coordination of benefits and it works like this:

Your spouse needs surgery, which costs $5,000. Your spouse's group policy has a $200 deductible, then pays 80% of the remaining $4,800 bill or $3,840. You and your spouse are now responsible for $960. This is where your group insurance coverage comes in, and providing the procedure was covered under your group plan, your coverage would pay the rest of the bill, including the $200 deductible. The caveat is that each spouse's insurance company must be aware of the other so they can coordinate payments, and not overpay. You cannot be paid or reimbursed for more than 100% of the cost of the treatment; it is illegal so full disclosure to each group plan, of secondary coverage, is required.

What about the kids?

Children can also be covered under both insurance plans, but the rules are just a little different. While each insurance plan still needs to be notified of the dual coverage, the primary coverage is determined according to birth dates. If your birthday is February 2, and your spouse's birthday is February 16, your coverage is the primary insurance for the kids. The year of birth doesn't matter; this isn't about age, it's just the method used to determine primary coverage.

Divorced families where both parents have insurance but one has group insurance and the other has private health insurance have their children's primary coverage determined in their divorce decree. Often states have rules governing the insurance of minor children. For example, the custodial parent may be the primary insurer, while a few states still require the father, if he has coverage, to be the primary. If the parents' plans are both group or both individual plans, the birthday rule must be followed to determine the primary insurance plan. The level of coverage of each parent's plan doesn't play a factor in determining primary coverage.

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