The plans set forth rules to determine which plan pays first, (“primary”) and which plan pays afterwards (“secondary”).
The general rule is that the plan that covers you as an enrollee is the primary plan and the plan which covers you as a dependent is the secondary plan.
How do you determine primary and secondary insurance?
Primary health insurance is the plan that kicks in first, paying the claim as if it were the only source of health coverage. Then the secondary insurance plan picks up some or all of the cost left over after the primary plan has paid the claim.
Can I have primary and secondary dental insurance?
Some dental plans have a “non-duplication of benefits” clause which applies when you have more than one dental insurance plan. This means your secondary health plan will not pay any benefits if the primary plan paid the same amount or more than what the secondary plan allows for the same procedure and dentist.
How does it work when you have 2 insurances?
Coordination of benefits is the process in which someone with two health insurance plans can receive coverage. The way that this works is that one plan becomes your primary and one plan becomes your secondary. Then your secondary insurance plan kicks in and covers the rest of the cost if it’s covered and necessary.
Can you have 2 dental plans at the same time?
Absolutely. However, even though you may have two dental benefit plans, there is no guarantee that both plans will pay for your services. Some secondary plans will not pay until you have exhausted the entire maximum of your primary coverage.
How do I know if Medicare is my primary insurance?
Medicare is primary when your employer has less than 20 employees. Medicare will pay first and then your group insurance will pay second. If this is your situation, it’s important to enroll in both parts of Original Medicare when you are first eligible for coverage at age 65.
Will secondary pay if primary denies?
Secondary insurance pays after your primary insurance. If your primary insurance denies coverage, secondary insurance may or may not pay some part of the cost, depending on the insurance. If you do not have primary insurance, your secondary insurance may make little or no payment for your health care costs.