Understanding Primary Health Insurance: How It's Determined

Dependents are often covered by two separate healthcare insurance programs. If the dependent needs treatment under the policies, one is referred to as the primary policy and it covers the bulk of the billing. The other covers what is left through a coordination of benefits.

Birthday Rule

• Almost all insurance companies use the "birthday rule." Of the two policy holders, the one with the earlier birthday in a calendar year is normally designated the primary policy holder.

Never Changes

• This birthday rule applies to every incident with the same individual policy holders. If Fred's birthday is March 11 and his wife, Sue, was born on November 11, Fred's insurance will always be the primary for the dependents.

Not A Law

• The rule is not required by law and a few insurance companies have different rules. It is best to check with your individual insurance company when a claim is processed to see who takes precedence.