![double coverage](https://blog.bernieportal.com/hubfs/Lauren%20Brown.png)
Written by
Lauren Brown
Lauren is an aPHR®-certified member of the Marketing team at Bernard Health. She writes about healthcare insights, employment law, and HR solutions.
Navigating Secondary Health Insurance Coverage
![Navigating Secondary Health Insurance Coverage](https://blog.bernieportal.com/hubfs/Stock%20images/Insurance%20Plans%20-%20Ring%20Binder%20on%20Office%20Desktop%20with%20Office%20Supplies.%20Business%20Concept%20on%20Blurred%20Background.%20Toned%20Illustration..jpeg)
Managing employee health benefits is a vital aspect of HR. But what happens when employees are covered under two health insurance plans? Whether due to marital status, age, or life circumstances, double health insurance coverage can lead to questions and complexities. Here’s everything employers need to know to help their teams navigate dual health coverage.
Reasons For Dual Health Insurance Coverage
Employees may be covered by two health insurance plans through a process called coordination of benefits (COB), where both providers collaborate to manage and pay claims for the individual.
Below are the most common instances of dual coverage:
- Marriage: Employees are covered under their employer-sponsored plan and their spouse’s plan.
- Under 26 Years Old: Employees remain on their parent’s insurance while also enrolled in their employer’s plan.
- Divorced Parents: Dependents may be covered under both parents’ separate plans.
- Separate Employer Coverage: Both parents have coverage from their employers, and dependents are covered under both plans.
- Working Seniors: Employees over 65 are covered by Medicare and their employer’s plan.
How Does Double Coverage Work?
When employees have two insurance plans, one becomes the primary provider, and the other acts as secondary coverage. Here’s how it works:
- Primary Insurance: Pays first, covering up to its limit.
- Secondary Insurance: Covers remaining costs, up to 100% of the bill.
Even with both plans, out-of-pocket costs may still apply. Determining which plan is primary depends on specific rules. For example, the "birthday rule" is a guideline used by health insurance companies to determine the primary plan for instances regarding dependent children. The plan of the parent whose birthday (month and day) comes earlier in the calendar year is considered primary, while the other parent’s plan serves as secondary coverage.
Common Questions Surrounding Dual Coverage
Employees with dual health insurance coverage may turn to their HR team with questions about how their plans work. While detailed inquiries are best directed to the insurance providers, HR teams should be prepared to address common questions employees may have about managing two health plans. Here are some common questions HR pros should be ready to address:
1. Can I Choose Which Insurance to Use for Each Visit?No. The primary insurance always pays first, followed by the secondary plan. Network flexibility depends on the primary plan type (e.g., PPO or HMO).
2. Do I Have to Pay Two Premiums and Deductibles?
Yes. Employees are responsible for premiums and may have separate deductibles for each plan. Encourage employees to assess whether the extra cost aligns with their healthcare needs. For instance, a young, healthy employee might find it unnecessary to maintain two plans if one offers sufficient coverage.
3. What Happens if I Move to Another State?
Coverage depends on the insurance provider’s network. Major providers typically offer national networks, while state-specific plans may require adjustments to ensure in-network access in the new state.
Additional Resources
You can stay informed, educated, and up to date with important HR topics using BerniePortal’s comprehensive resources:
- BernieU—free online HR courses, approved for SHRM and HRCI recertification credit
- BerniePortal Blog—a one-stop shop for HR industry news
- HR Glossary—featuring the most common HR terms, acronyms, and compliance
- Resource Library—essential guides covering a comprehensive list of HR topics
- HR Party of One—our popular YouTube series and podcast, covering emerging HR trends and enduring HR topics
![double coverage](https://blog.bernieportal.com/hubfs/Lauren%20Brown.png)
Written by
Lauren Brown
Lauren is an aPHR®-certified member of the Marketing team at Bernard Health. She writes about healthcare insights, employment law, and HR solutions.
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