How Does Dual Health Insurance Work?

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   Marlin McKelvy

   President, Consumer Directed Benefit Solutions, Memphis, Tennessee

   I presume you are asking about a situation where a person has health insurance through their employer and is also covered as a dependent under their spouse's or perhaps parent's health plan.  In these increasingly rare dual coverage situations a process called coordination of benefit applies.  The general rule is that the person whose birthdate comes earliest in the year has the policy that it primary (first to pay on the claim) and then the other policy pays in a secondary capacity covering what the primary policy has not paid (subject to the coverage terms of both policies).  In no case can the total amount paid by both policies exceed 100% of the health claim amount.

   Answered on May 13, 2014

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