When Should You Submit a Claim to a Secondary Insurance Company?

You can't pick which parental policy is primary for children's coverage.

You can't pick which parental policy is primary for children's coverage.

It's not that unusual to have two health insurance policies covering one family. For example, you and your partner may have two separate policies from two separate employers. When you need to file a claim, you file first with the primary insurer. Only after that insurer pays -- or doesn't -- do you submit a claim to the other company.

Primary Coverage

If you're covered by your health insurance and your spouse's, your own insurer is always the primary for your own medical bills. For your kids, the usual rule is that whichever parent has the first birthday of the year is the primary. If you and your spouse have the same birthday, whichever of you has had coverage longest provides primary insurance.

First Things First

The fundamental rule of having double coverage is that you don't get double the benefits. You're never supposed to receive more from your insurer than you paid to the doctors. When you go into the hospital or pick up a prescription, you present your primary insurer's information. You don't submit a claim to your secondary insurer until you see how much your primary coverage pays for. If your primary coverage pays 100 percent, you don't contact your secondary insurer at all.

Secondary Coverage

Once you see what your primary coverage leaves you on the hook for, you can file a claim with the secondary insurer. For example, suppose a trip to the ER leaves you paying for a $40 deductible and $200 in unreimbursed medical bills. You then contact your partner's insurer and file a claim for $240. Depending on the policy, the secondary insurer may cover some or all of the bills.

Limits of Coverage

You can't use your primary/secondary arrangement to double up on services. If, say, both your dental plans pay for two teeth cleanings a year, you can't submit claims for four cleaning sessions. Some insurers have specific rules for coverage when they're the secondary insurer, which may reduce how much they pay out. Read your policy and contact your insurer ahead of time. If you know the rules, you can avoid unpleasant surprises.


About the Author

A graduate of Oberlin College, Fraser Sherman began writing in 1981. Since then he's researched and written newspaper and magazine stories on city government, court cases, business, real estate and finance, the uses of new technologies and film history. Sherman has worked for more than a decade as a newspaper reporter, and his magazine articles have been published in "Newsweek," "Air & Space," "Backpacker" and "Boys' Life." Sherman is also the author of three film reference books, with a fourth currently under way.

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