Pros and cons of having two health insurance policies
The advantage of having two health insurance plans is that they cover more medical costs and out-of-pocket expenses than a single plan. The primary insurance plan may cover what the second plan does not. The secondary health insurance plan may cover the copays, deductibles and coinsurance of the first plan.
The disadvantages of multiple health insurance plans include paying separate premiums and deductibles, complicated filing procedures, and reimbursem*nt delays.
How dual health insurance coverage works
Having two health insurance plans doesn’t mean the insured gets twice the benefits. The most they can get from the health insurance policies combined is 100% of their medical expenses.
The way it works is that one plan is designated as primary insurance and the other as secondary. A claim goes first to the primary insurance plan, which pays medical bills the way it normally would. It is only after the primary insurer pays the claim that it gets submitted to the secondary plan.
How do you determine which plan is primary?
The health insurance companies, not the insured employees, decide which are considered the primary and secondary plans. When there are multiple health insurance policies, the companies follow the coordination of benefits (COB) model guidelines developed by the National Association of Insurance Commissioners. There may be differences in the ways that some states and insurance companies make assignments. However, many rules are generally agreed upon.
For example, if someone has a plan from their employer and is also covered on their spouse’s plan, their plan is considered primary. The plan on which they are a dependent is considered secondary insurance. Medicare plans are usually primary, and Medicaid is usually secondary. COBRA continuation coverage is secondary.
An insurance company should include information about its coordination of benefits in its policy documents.
Tips for filing claims with multiple health insurance policies
These tips help make the process of working with dual coverage go more smoothly:
Review the information on COB in the plans’ documents.
Notify both insurance companies about the existence of the separate health insurance plans.
Inform your doctors and other medical providers about your dual coverage.
After the primary claim is processed for covered health expenses, you’ll receive an explanation of benefits (EOB). File a claim with the secondary plan and provide them with a copy of the EOB.
Keep track of your out-of-pocket costs and medical coverage reimbursem*nts and check it all for accuracy.
The birthday rule
The birthday rule applies when a child is covered by both parents. It states that the primary plan belongs to the parent whose birthday comes first during the calendar year. If the parents share the same birthday, the one with the longest-running is the primary plan.
Multiple plans for dental and vision health coverage
The most common dual-coverage situation is one in which someone is covered by two medical insurance plans. It’s also possible to have two dental plans or two vision plans if an employee is covered by their plan and also their spouse’s. When this happens, coordination of benefits works the same way as with two medical plans. One plan is designated primary, the other secondary, and the secondary plan takes effect after the primary has paid.
Get help with employee benefits
As an employer, you know how important it is to your employees to have good health insurance coverage. Small companies can't always offer the best in employer-sponsored health insurance on their own. TriNet can help. Our PEO services give small businesses access to many of the same health insurance plans and benefits options that big companies enjoy. To learn more about TriNet's HR, payroll and benefits services and solutions, speak with a knowledgeable representative today.
FAQs
The short answer to that question is yes, you can have two health insurance plans. In fact, it's becoming increasingly common for individuals to have more than one health insurance plan.
What happens if you have two health insurance at the same time? ›
If you have a primary and secondary health insurance, your bill will not be given to both of them at the same time. Your primary insurance will typically be billed first unless there is a rule under your Coordination of Benefits provision that decides which insurance pays first.
Is it worth having two health insurances? ›
Multiple plans can offset more costs, increasing your savings when receiving healthcare. For example, your primary insurance might only cover 80% of a specific procedure. If your secondary insurance covers the rest, you bear no cost.
Which insurance is primary when you have two? ›
Usually, your employer's plan is primary. If you also are covered by your spouse's plan, that plan is usually secondary. There are other rules for many other situations. A special case may come up if you have both medical and dental insurance, and you have a procedure such as oral surgery.
Can I have my own health insurance and be on my parents at the same time? ›
Yes, you can have your own health insurance plan while staying on your parents' policy. This is called having dual coverage.
How do you determine which insurance is primary? ›
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
What does secondary insurance mean? ›
Secondary insurance is health insurance that pays after primary insurance on a claim for medical or hospital care. It usually pays for some or all of the costs left after the primary insurer has paid (e.g., deductibles, copayments, coinsurances).
How do copays work with two insurances? ›
In most cases their secondary policy will pick up the copay left from the primary insurance. There are some cases where the secondary policy also has a copay and those patients may end up with a copay applied after both insurances process the claim.
Is it better to have joint or separate health insurance? ›
If you are both in good health, you may save the most money with a family health insurance plan. If one spouse has chronic health issues and the other is healthy, couples may save more by choosing a lower deductible plan for one partner and a higher deductible, lower-cost plan for the other.
What is double insurance? ›
Double insurance refers to the method of getting insurance of same subject matter with more than one insurer or with same insurer under different policies. This means that one can get insurance policies on a subject matter more than its value. Double insurance is possible in all types of insurance contracts.
How do you determine which health insurance is primary? Determining which health plan is primary is straightforward: “If you are covered under an employer-based plan, that is primary,” Mordo says. If you also were covered under a spouse's plan, that would be secondary, he adds.
When a patient has dual coverage the primary insurance is? ›
General Coordination of Benefits Rules
Employee/Main Policyholder - When both plans have COB provisions, the plan in which the patient is enrolled as an employee or as the main policyholder is primary. The plan in which the patient is enrolled as a dependent would be secondary.
Why do insurance companies ask if you have other insurance? ›
Knowing about other policies helps insurers determine the policyholder's financial exposure and ensure that the coverage amount is appropriate.
Can you have two different health insurance at the same time? ›
The short answer to that question is yes, you can have two health insurance plans. In fact, it's becoming increasingly common for individuals to have more than one health insurance plan.
How does dual insurance work? ›
The way it works is that one plan is designated as primary insurance and the other as secondary. A claim goes first to the primary insurance plan, which pays medical bills the way it normally would. It is only after the primary insurer pays the claim that it gets submitted to the secondary plan.
Do I lose my parents' insurance the day I turn 26? ›
You lose your parents' health insurance in California when you turn 26.
When two insurance policies cover the same risk? ›
Concurrent insurance is when two insurance policies are held to cover the same risks over the same time period. Concurrent insurance usually includes a primary policy, with the second policy meant to act as excess coverage.
What are the coordination of benefits rules? ›
The COB Process:
Ensures claims are paid correctly by identifying the health benefits available to a Medicare beneficiary, coordinating the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first.
