What happens if an employee patient has coverage under two insurance plans?
Asked by: Hadley McLaughlin MD | Last update: October 6, 2025Score: 4.7/5 (26 votes)
Can you be covered under two insurance plans?
Yes, you can have two health insurance plans and it is perfectly legal, but it is also important to fully understand how primary vs secondary insurance operates.
When a patient has dual coverage, the primary insurance is?
Final answer:
The primary insurance plan for a patient with dual coverage is typically the one where they are the policyholder, with the dependent coverage acting as the secondary payer.
When a patient has two insurances and they must be coordinated?
When a person is covered by two health plans, coordination of benefits is the process the insurance companies use to decide which plan will pay first for covered medical services or prescription drugs and what the second plan will pay after the first plan has paid.
Do you still pay a copay if you have two insurances?
In most cases their secondary policy will pick up the copay left from the primary insurance. There are some cases where the secondary policy also has a copay and those patients may end up with a copay applied after both insurances process the claim.
Can Employees Have Two Health Insurance Plans?
How do deductibles work with two health insurances?
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.
How do you determine which insurance is primary and which is secondary?
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
What happens if a patient is covered by two different policies?
Having two health plans doesn't mean you'll receive full medical coverage twice. Instead, one policy will be your primary plan, and the other will be your secondary health coverage. This ensures the total amount your two plans will pay for your health expenses will never exceed 100% of the cost of those expenses.
What is the coordination of benefits for two insurances?
Coordination of benefits is the process insurance companies use to determine how to cover your medical expenses when you're covered by more than one health insurance plan. It clarifies who pays what by determining which plan is the primary payer and which is secondary.
What is the birthday rule?
The rule requires that the parent whose birthday comes first in the calendar year would cover the cost of delivering the new baby regardless of whether one parent has better health coverage for a newborn than the other.
Do you have to bill a patient's secondary insurance?
A: The answers to your questions depend on state law. Some states require physicians to bill all insurers a patient has, without charge, whereas others do not. If the physician has a contract with the secondary insurer, then, by contract, he or she most likely is obligated to submit the bill.
What does dual coverage mean?
In a dual coverage scenario, the primary carrier (or primary plan) will pay a larger portion of the benefits, while the secondary carrier (or secondary plan) pays a smaller amount.
What is double insurance?
Double insurance refers to the method of getting insurance of same subject matter with more than one insurer or with same insurer under different policies. This means that one can get insurance policies on a subject matter more than its value. Double insurance is possible in all types of insurance contracts.
Can you be under 2 different insurances?
Although no laws prohibit you from purchasing two auto policies from two different companies, an insurer will not allow you to purchase two policies on the same car. If you have an auto accident, filing two claims with two different insurance providers constitutes insurance fraud even with two auto policies.
Can I have a high deductible health plan and a secondary insurance?
Other coverage that is allowed in addition to an HDHP
The IRS does allow you to have some types of coverage in addition to your HDHP, without jeopardizing your eligibility to contribute money to your HSA.
Does secondary insurance need to be in network?
The answer is no. The advantage of a supplemental health insurance policy is it provides coverage regardless of the network restrictions under the comprehensive health care policy.
How does it work when you have two health insurances?
The way it works is that one plan is designated as primary insurance and the other as secondary. A claim goes first to the primary insurance plan, which pays medical bills the way it normally would. It is only after the primary insurer pays the claim that it gets submitted to the secondary plan.
Will secondary pay if primary denies?
It depends on which insurance is considered “primary” and which is “secondary.” The insurance that pays first (primary payer) pays up to the limits of its coverage. The insurance that pays second (secondary payer) only pays if there are costs the primary insurance didn't cover.
Can you have two insurance policies covering the same risk?
If you have two or more active insurance policies that cover the same insured risk, this is known as dual insurance. Sometimes policyholders purchase another policy without realising that they're already covered for the risk they want to insure. Being dual insured can cause complications if you need to make a claim.
When a patient has two insurances and they must be coordinated to determine?
Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an ...
What is a policy on two people that pays benefits only after both of the insureds have died?
Survivorship life insurance is a type of joint life insurance policy designed to cover two people on a single policy. These policies, also known as second-to-die joint life insurance, only pay out a death benefit once both policyholders have died.
When a patient is covered by a primary payer plan and a different secondary payer plan?
The "primary payer" pays up to the limits of its coverage, then sends the rest of the balance to the "secondary payer." If the “secondary payer” doesn't cover the remaining balance, you may be responsible for the rest of the costs.
How do deductibles work when you have two insurances?
Double the Fixed Costs
Two health insurance plans mean paying two premiums and deductibles. This situation means a greater monthly cost for premiums and a higher out-of-pocket cost to satisfy the deductible limit for each plan.
Who is responsible for paying for out of pocket expenses on a patient's account?
Out of Pocket Costs: Health care expenses that the patient is responsible for as they are not fully or partially covered by their plan.
What is the coordination of benefits rule?
“Coordination of benefits” or “COB” means a provision establishing an order in which plans pay their claims, and permitting secondary plans to reduce their benefits so that the combined benefits of all plans do not exceed total allowable expenses.