- An adult child might be covered under a parent's plan (which must be allowed until age 26), and also has a job with workplace benefits.
- An employee might take his or her company's health plan and also be enrolled under a spouse's plan at the spouse's workplace.
Coordination of benefits rules: Who pays first when you have two group health plans?
|Your workplace plan||Your parent's plan|
|Your workplace plan||Your spouse's workplace plan|
- Double coverage often means you're paying for redundant coverage.
- You must make your claim with your “primary” plan first. The other plan can pick up the tab for anything not covered, but it won't pay anything toward the primary plan's deductible.
- If both plans have deductibles, you'll have to pay both before coverage kicks in.
- You don't get to choose which health plan is primary, meaning the one that pays first. You don't get to choose which insurer will pay a certain claim. However, if the first insurer doesn't cover a certain treatment, or covers it only partially, you can then submit the remainder of the claim to your secondary insurer for payment, assuming the treatment is covered under the second plan.