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| Family and Health Insurance |
 In defining which plan is primary and which is secondary, a plan without a COB provision is generally considered primary. If your both plans have COB rules, the plan in which you are enrolled as an employee or as the main policyholder is primary. Secondary plan is the plan in which you are enrolled as a dependent — on your husband's plan, for instance.
Besides, if you have COBRA coverage as well as coverage with another plan in which you are enrolled through an employer, your COBRA plan would be secondary and the employer plan primary. If any of the above provisions does not determine which plan is primary, the plan covering you the longest is typically considered primary (although some insurers might say the claims are shared equally by both plans).
Your situation defines which of these provisions applies, but you can use these guidelines to help sort it out.
Keep in mind, dual coverage can be expensive, and if one of your plans is an HMO, be especially certain that it makes financial sense to pay for them both. You probably don't want to pay more than you'll ever get back in benefits by having dual coverage.
Question
I have two children and I am divorced. Can they be covered under my health plan and my husband's health plan at the same time? And how do we know which health plan pays for their medical claims?
Answer
More than one health plan can cover children and even adults; it's common for divorced parents to include their children on each health plan in order to maximize their benefits.
When you're covered under multiple health plans, they'll have to coordinate your benefits, so that they aren't both paying for the same claims. In fact, you cannot come out ahead by having each plan reimburse you so that the total they pay is more than 100 percent of the cost of your medical claim; they don't want you pocketing extra money.
If children are covered under each parent's group health plan, one plan is considered "primary" and the other is considered "secondary." Primary plan pays the cost of the claims first. The plan that is the secondary pays any remaining costs not covered by the primary plan — as long as the medical care is actually a covered benefit under the secondary plan. It won't reimburse you for services that aren't covered.
You should know which plan is primary and which is secondary.
An informal practice called the "birthday rule" is used in the health insurance industry. Under the birthday rule, the health plan of the parent whose birthday comes first in the calendar year is determined as the primary plan. Keep in mind that it doesn't matter which parent is older, since the year of birth is not a factor. For example, if your birthday is July 15, 1955, and your ex-spouse's is Sept. 17, 1953, your health plan would be considered primary because your birthday comes first in the calendar year.
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