YOU ASK:

If two parents carry insurance for a child, whose is considered the primary?

WE ANSWER:

There are certain rules on choosing which policy is primary.

  • The general rule is that the policy that has the earliest effective date is the one that is considered the primary coverage.
  • Another rule (commonly referred to as the birthday rule) is based on which parent has the earlier birth date (month and day). The insurance of the parent with the earlier birth date becomes the primary insurance. If both spouses have the same birthday, the policy of the one who has been employed the longest by his or her employer will be the policy considered as the primary cover.
  • There are also instances where one spouse is covered by an employer-sponsored health insurance while the other spouse is covered through Medicare or VA insurance. In this case, the plan that is employer-sponsored becomes the primary insurance, with Medicare or VA insurance as the secondary coverage.

Other policies also give the parents that freedom to assign which policy to designate as the primary insurance. This may be based on which insurance plan provides the better benefits. Of course, the policy that offers the more comprehensive coverage will be chosen as the primary insurance.

Divorce

Now, if the two spouses are divorced, the policy of the custodial parent is the primary cover. The divorce papers will state which spouse has the responsibility for ensuring healthcare.

Claims on the Primary or Secondary Policy

This means that when the time comes that your child needs to claim against the insurance, he will first claim on his primary insurance. Please take note that if you and your spouse's health insurance coverage is virtually the same (i.e. having the same deductible or the same co-insurance), it really would not make a difference from your end because you will receiving the same coverage either way. But, the choice of primary or secondary insurance will be important to insurance companies since they will be the ones who will end up paying for the claims.

The good thing is that having insurance coverage from both parents can help decrease the out-of-pocket health expenses you may incur, depending on how well-coordinated the two policies are.

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