condition insurance Rules

Many dual wage couples, comprise their children on each group health guarnatee plan to maximize benfits. However, without some sort of principles in place to help the health guarnatee fellowships coordinate benefits, it's possible that either you or your physician would be reimbursed for more than 100 percent of the actual cost of your claim.

To forestall this, health guarnatee fellowships typically prescribe one parent's health guarnatee plan as the primary plan and the other as the secondary plan. (That's why the patient questionnaire at your doctor's office asks for information on primary and secondary coverage.) The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in.

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The Date Of Birth Determines Which health guarnatee Provides Coverage

The birthday rule is often used to conclude which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor not the year so it doesn't matter which spouse is older.

Like most rules, the birthday rule has exceptions:

- If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.

- If one spouse is currently employed and has health guarnatee through a current employer, and the other spouse has coverage through a old employer, the plan belonging to the curently employed spouse would be primary.

- In the event of divorce or seperation, the plan of the parent with custody ordinarily provides primary coverage. If the custodial parent remarries, the new new spouse's coverage becomes secondary. And finally, the non custodial parent's health guarnatee plan would provide a third layer of guarnatee protection. This order of payment can be altered by a court issued divorce conclude or by agreement, but the health guarnatee fellowships must be notified.

These Are Just health guarnatee Rules Not The Law

Keep in mind that these practices are tasteless among health guarnatee companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy determined to make sure you understand how your guarnatee enterprise handles dual coverage. If the policy coverage is unclear, ask for help from your employers benefit devotee or your insurer's buyer assistance department.

condition insurance Rules