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Can you designate the primary and secondary insurance coverage yourself?

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Anonymous
2020-03-26 20:16:47
2020-03-26 20:16:47

Medicare

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2015-07-15 20:54:45
2015-07-15 20:54:45
Primary and Secondary CoverageIt may depend on your local regulations but typically which policy is primary is dictated by law and by the terms of your insuring contracts. The default is as follows. Exact Same coverages on both policies / Duplicate coverageThe policy with the earliest effective date is Primary unless the second policy was intended to replace the first. Policies with different coverages.The Policy which has the broadest coverage will be considered primary.

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Designating Primary and Secondary Insurance CoverageHere are opinions and answers from Wiki s Contributors:
  • Since it was court ordered for their mother to provide health insurance, I believe that that insurance would be considered primary...yours would be secondary. I had a similar problem before and a few people told me the same...so sorry their mother's health insurance would become their primary coverage.
  • Would your ex-wife be willing to pay for the kids' coverage directly to your insurance company? By paying directly to the company, this avoids "power plays," and she might not feel as resentful about the situation. Plus, you could let her know that you would pick up a rider policy that she can use when she has the kids. That way, you both have 100% coverage on your children. If the insurance is paid through your employer, talk to your lawyer first and see what creative options he/she's seen done in these type of cases. If you're going to pay for insurance regardless of her converage, maybe she can pay you a slightly higher child support payment (assuming she has to make one) and you would then be responsible for insurance as long as you are capable of working. In my personal experience, all it takes is an addendum page drawn up by your lawyer, and then submitted to both her and the courts. The courts will accept almost any agreement within reason as long as it is beneficial for all parties including and especially the children. I wouldn't give up on this especially if both of you are making insurance payments. If your ex-wife is able to speak coherently to you at all, you should be able to resolve this by using the reasoning that you are trying to get the most coverage for the children while maintaining current, established medical relationships with their medical personnel, namely their pediatricians and their staffs. If she can understand that a divorce is hard enough without adding one more change, she will be willing to work something out especially if you are willing to pay for insurance regardless of what she does. That shows her that you are serious about this and that it's not a power play. Good luck to you. I know how hard divorce can be on everyone. Luckily with time, it does get better and easier.
  • If you are married, both have medical insurance and have children, you would follow the "birthday rule". The parent with the birthday that falls earliest in the calender year (no matter what the birthyear is) would be the primary insurance. For example. Mrs. Smith was born May 3, 1945 and has Blue Cross that she has carried for 15 years. Mr. Smith was born June 10, 1939 and has had Aetna for 20 years. The primary insurance would be Mrs. Smith's policy as she was born on May 3rd which comes before June 10th. If both parents have the same birthday (it does happen), then you defer to the policy that has been in place the longest. So, if Mr. And Mrs. Smith had the same birthday month and day, then Mr. Smith who has had insurance for 5 more years than Mrs. Smith, would have the primary insurance policy.
  • The birthday rule above does exist, but court orders supercede the birthday rule. Only use the birthday rule if there is not a court order involved, like a current husband and wife both cover their children under their employer's insurance. The idea about dropping one of the insurances and just having her pay the cost is a good one. Most court orders just say who has to pay for the insurance, not how it is provided.
  • No. Here's the rules from Delta Dental's Web site: What is dual coverage? If you're fortunate enough to be covered by two dental plans, you have what is called dual coverage. Dual coverage doesn't mean that your benefits are doubled. What it does mean is that you will likely enjoy lower out-of-pocket costs for your dental care. Dual coverage works the same way whether you are covered by two Delta Dental plans or by Delta and another carrier. Delta Dental simply works with the other dental carrier to coordinate your benefits. Who is the primary carrier? The first or primary carrier is the one that covers you as a primary enrollee (e.g., your employer rather than your spouse's employer). If you have two jobs, the plan that has covered you longer is considered primary. For your children's coverage, the primary carrier is generally determined by the birthday rule: coverage of the parent whose birthday (month and day, not year) comes first in the year is considered to be your children's primary coverage. The birthday rule may be superseded by a divorce agreement or other court ruling. How does dual coverage work? Suppose, for example, that both of your plans provide two cleanings a year, each with 80 percent coverage. The primary carrier pays 80 percent, and the secondary carrier usually covers up to the remaining 20 percent that you would have had to pay out-of-pocket if covered by only one plan. You would not, however, be entitled to four cleanings per year. Why not twice as many benefits? Why don't you receive double the benefits when you have two dental programs, especially if your dentist recommends that you receive more than two cleanings per year? Dual coverage limitations, like all other program limitations, are built into your group's contract and into the rates your group pays for your coverage. These contracts are set up to provide affordable dental care to a maximum number of people. Given the choice between doubling one individual's benefits or providing a greater scope of benefits to more people in the group, most group purchasers choose to spread their benefit dollars more evenly. What if you have non-duplication of benefits? For groups with a non-duplication of benefits rule in their plan, the secondary carrier pays only the difference between what the primary carrier actually paid and what the secondary carrier would have paid if it had been the primary carrier. For example, if the primary carrier paid 80 percent and the secondary carrier normally covers 80 percent as well, the secondary carrier would not make any additional payment. However, if the primary carrier had only paid 50 percent, the secondary carrier would pay up to the remaining 30 percent. Dual coverage saves money for you and your group by sharing the total cost of dental benefits between two carriers. Containing costs is an important part of Delta's plan to keep you smiling. Sample coordination of benefits: Procedure Primary carrier pays 80%, Cleaning $80 $64 $16 $0.
  • When it comes to children, it falls under the "Birthday Rule". The parent whose birthday comes first is primary. For example if mom is January 1,1952 and dad is February 2, 1951, then mom would be primary. The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in. The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor-not the year-so it doesn't matter which spouse is older. Like most rules, the birthday rule has exceptions: If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children; If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer (e.g., through COBRA), the plan belonging to the currently employed spouse would be primary; and In the event of divorce or separation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new spouse's coverage becomes secondary. And finally, the non-custodial parent's plan would provide a third layer of insurance protection. This order of payment can be altered by a court-issued divorce decree or by agreement, but the insurance companies must be notified. Keep in mind that these practices are common among insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy language is unclear, ask for help from your employer's benefit specialist or your insurer's customer service department.
  • Here's the 43 page booklet from Medicare http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf.
  • The answer simply put is no. the order of liability is determined by general rules (such as the birthday rule) or by a court order. In the case of dual coverage through a single individual (someone with two jobs) the effective date determines which is primary - I've never come across a situation where someone could choose themselves.
  • The question is not specific enough. Coverage for yourself or for your children? This can get really tricky and no you cannot designate coverage - it's dictated by the insurance coordination of benefits rule written in the employer's contract when they sign up for coverage. Here are a few scenarios: 1. If you are the insured and have coverage through 2 different employers rule is the employer that you have been with the longest will be primary. 2. If you have coverage through your work and your spouse's work then yours will be primary - ALWAYS...NO EXCEPTION. 3. If you have government coverage like Medicare or Medicaid and also have private insurance from work then again your work insurance will be primary and government insurance secondary. 4. If children have coverage through both parents and they are not divorced the birthday rule takes effect. Whoever birthday comes first that's primary. 5. If children have coverage through both divorced parents then primary is the parent with whom they reside. If they have 50/50 custody then the birthday rule applies again. These terms are usually dictated in the contract between the insured and the specific insurance company. Hope it helps.
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