What is the Health Insurance Birthday Rule?

When a married couple or domestic partners have health coverage through work, they can maximize their benefits by signing their child or children up for both plans. However, one plan will generally be designated as primary coverage and cover health expenses up to that plan’s limits. The second parent’s plan will be considered secondary coverage and cover the remaining portion of the bill to its limits.

The birthday rule is one way in which many insurance companies determine which parent’s health insurance plan becomes the primary plan and which becomes the secondary plan. The parent whose birthday falls first in the year will generally be designated as the primary insurance, while the parent whose birthday falls later in the year will be designated as the secondary insurance.

Not all parents have typical insurance situations, however. If both partners were born on the same day, the parent who enjoyed the longest continuous health care coverage will be named the primary insurance provider. The other parent’s insurer will automatically become the secondary insurer.

If the parents are divorced, the custodial parent will automatically provide primary insurance coverage. His or her spouse, if the child is covered under that individual’s group health insurance plan, will then be the second payer. If the child is not covered under that plan, then the noncustodial parent’s plan will be the secondary insurer. Otherwise, the noncustodial parent’s insurer will be the tertiary payer.

The birthday rule is not a law but rather a general guideline for individual health insurance companies. Not all insurance companies follow these guidelines, or they may not follow them strictly. Furthermore, court orders or divorce decrees may alter this arrangement.

To learn more about how your insurance handles primary and secondary coverage, read your policy carefully or talk to one of our qualified insurance agents.

Source: Health Care Los Angeles

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