Q:

How do you determine primary and secondary health insurance coverage?

A:

Quick Answer

When you have health insurance from two or more providers, various criteria are used to determine the primary coverage, according to the Illinois Department of Insurance. The main factor considered is whether you are a primary subscriber or a dependant in the insurance coverage.

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Full Answer

The health insurance plan that offers coverage for an employee, subscriber or member is considered the primary payer over the plan that covers a person as a dependent, retiree or laid-off employee, according to the Illinois Department of Insurance. All things being equal, the plan that you have subscribed to for the longest is the primary payer.

In certain cases, such as in a no-fault accident, the accident coverage is considered the primary payer and the health insurance coverage is the secondary payer, according to the Centers for Medicare and Medicaid Services. Similarly, Workers' Compensation payments are considered primary if a worker is entitled to compensation of injuries sustained at work before Medicare payments are made.

When a person has more than one health insurance coverage, the primary payer makes the first payment, which means that it pays until reaching the limit of the coverage before the secondary payer takes over, according to the Illinois Department of Insurance. The terms do not mean that the primary payer makes the first payment.

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