When a family has two health insurance plans there are industry rules regarding which plan is considered primary. The rules may vary by state. The primary carrier pays the claim as if no other insurance was in place. The secondary carrier then pays any unpaid balances (deductibles, copays, coinsurance) in accordance with its plan design.
The plan of the member is usually considered primary. When children are covered under two plans the birthday rule often applies. The plan covering the parent whose birthday occurs first in a calendar year is considered the primary plan.
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The plan of the member is usually considered primary. When children are covered under two plans the birthday rule often applies. The plan covering the parent whose birthday occurs first in a calendar year is considered the primary plan.