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 Posted: Tue Aug 18, 2009 11:59 pm Post subject: Birthday Rule |
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My co-worker stated that if we were married and he had health insurance coverage and I had separate health insurance covered (different employers), that the birthday rule would apply even to spouses.....not just the kids...He stated that if I was covered under his policy and my policy, the birthday rules applies....
I never heard of this, but he insisted that the birthday rules not only applies to the children, but to spouses who have their own single (EE only) coverage....can anyone please explain. 08/18/2009 Thank you |
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valcal
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| Posted: Wed Aug 19, 2009 1:52 am Post subject: |
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| what is a birthday rule? |
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garry4
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| Posted: Thu Aug 20, 2009 10:30 pm Post subject: |
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| Yes this is what I am also wondering. I have never heard of such a thing and what would a birthday have to do with insurance? I could see if it were about the coverage. |
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fireyone
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| Posted: Sat Mar 13, 2010 6:05 am Post subject: birthday rule and insurances |
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first of all...to address the question at hand, your coworker is completely mistaken. the birthday rule is only a way to differentiate primary/secondary tertiary coverage for a couple's children.
(it gets even crazier when the birth parents get divorced and there are custodial things to keep in mind)...but let's say we have a perfect family here.
mom and dad both have ins and both ins cover little jimmy.
mom was born on 3/1/50 and dad was born on 5/1/49.
due to the birthday rule, mom's ins would be primary and dad's ins would be secondary (doesn't take account of the year...what matters is who's birthday falls first).
as for couples THAT do not have children...
if susan is married to joe and susan has ins that covers herself and joe, while joe has ins that covers himself and susan...the primary ins for each individual is their own ins.
so if susan has blue cross and joe has cigna.
one day joe gets sick and goes to the hospital..his cigna is primary and susan's blue cross become's joe's secondary
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anonymous111
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| Posted: Sat Mar 13, 2010 6:30 am Post subject: |
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anonymous111, nice post.
This is a statute in just about every state known as the "Coordination of Benefits" provision. It specifies the only with people who are covered by more than one group insurance contract and doesn't deal with individual insurance policies.
The "birthday rule" deals, as anonymous111 stated, with the children. Simple. Whichever parent was born earliest in the year is the primary provider of coverage and coverage under the spouse' policy would be secondary, or "excess." As stated, year of birth doesn't matter- it's month and day only. In the strangely not uncommon situation where each parent has the same birthday, it defaults to the parent who has been in their plan the longest as to who's primary.
One last thing to amplify is for a split-household. The birthday rule only applies to an intact household. Primary coverage normally goes with the custodial household; if a joint-custody arrangement exists, it typically goes with the physical custody parent. It's important to remember that these rules apply unless a family court dictates otherwise.
Finally, it muddies the waters when managed care plans, like HMOs and PPOs come into play and there's a difference in the type of plan benefits, cost-sharing arrangements, etc.
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InsTeacher
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| Posted: Mon Feb 21, 2011 1:13 pm Post subject: Medicare and dual insurance |
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My husband has medicare, his own insurance and is covered on my insurance. We are both retired and have insurance from our place of employment (state) where we retired. Does the "birthday rule" apply for the secondary insurance, or does his insurance cover him secondary? (my birthday comes first).
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nannyconnie
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