Secondary health insurance coverage is often the case when both spouses work and are provided with group health insurance as part of their employee benefits package. For families who may who have high medical bills, being covered under more than one health insurance policy can be a valuable asset as far as finances are concerned. Medicare beneficiaries also need a Medicare supplement to fill in the gaps for payment of health care costs not paid for by Medicare.
Coordination of Benefits
Family insurance coverage can be a complex issue. When families are covered under more than one health insurance policy, a coordination of benefits system requires that the two health plans work together to pay medical expenses covered by each plan. In most cases, as the employee, your own group health plan provides your primary coverage, paying its portion of a medical claim first. Your spouse's plan then pays its portion. Likewise, your spouse's health plan provides his primary coverage, and your health plan is his secondary payer. Children receive primary health insurance coverage through the parent whose birthday comes first. The other parent's plan reimburses any remaining expenses as allowed under the provisions of that group health plan. Benefits from primary and secondary insurance plans combined will never pay more than 100 percent of the expense billed.
Family Coverage
Fathers are not necessarily the primary insurer for a child when both parents work. In most cases, if both spouses are enrolled in a family plan through their employers, the spouse whose birthday occurs earlier in the year is designated as the primary insurer for any children. So if a mother's birthday comes before the father's, a child will be covered first under the mother's policy. The father's insurance plan would then provide the family with secondary coverage. Insurers generally consider the month and date of birth, not the year. In some cases, you may be given the option of choosing which insurance policy will provide your family's primary health coverage. When this is the case, couples usually select the plan that offers the most comprehensive coverage as their primary insurer.
Purchasing Secondary Coverage
Individuals or families can purchase secondary insurance coverage if they are covered under only one health insurance plan. The main advantage of having additional insurance is getting medical expenses paid that a primary plan does not cover. Sometimes a secondary insurer will pay a higher percentage of the cost for certain medical services. You can submit any remaining amount to the secondary insurer after the primary insurer has paid its portion. Choose a secondary insurance plan that will cover costs such as deductibles and co-pays, which the primary insurance does not.
Claims Process
Always submit health insurance claims to the primary insurance carrier first. After the primary insurer pays its maximum benefit, the insurance claim is submitted to the secondary insurer for payment of balances covered under the plan.
Problems
A common problem that occurs with secondary insurance coverage is in determining which insurance policy will provide primary insurance coverage and which will provide secondary coverage for a dependent child. Another problem is that people sometimes expect because they are paying a premium for additional health insurance coverage, they should be reimbursed for the cost of a medical service twice. This is not the case, as a secondary health plan is only responsible for paying the portion of medical expenses for which the primary plan has not paid.
Medicare
Individuals who are age 65 and older who are on Medicare need to purchase secondary insurance to pay for medical costs not covered by Medicare. Additional insurance coverage prevents Medicare beneficiaries from having to pay huge out-of-pocket medical expenses. Medicare Supplement Insurance or Medigap policies are designed so that both policies pay their shares of the costs for the health care services covered under each plan. Medigap policies also help cover certain costs toward which Medicare does not pay. These costs may include some outpatient surgeries and doctor visits. According to Medicare.gov, in order to make sure that you are adequately covered by health insurance, you and your spouse must purchase separate Medigap policies. One Medigap policy will not cover medical expenses for both spouses.
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