What is a birthday rule ?

Like many families, it is very likely that parents who have health insurance plans probably add their children to them. Usually, parents do this both to protect their kids and to maximize their benefits.

 Without some sort of system, the insurance companies wouldn’t be able to coordinate their benefits, and it is highly possible that you or your doctor would be reimbursed for more than 100 percent of the actual charge of your claim.

In order to prevent this, insurance companies designate one parent’s health insurance plan as tee primary plan, and they make the other parent’s plan a secondary plan for the child/children.

The primary plan will be paying covered expenses to the limits of the policy. If there were any unpaid costs, the secondary coverage will finish the job.

The “birthday rule” is usually used to specify which plan is primary and which plan is secondary.

Using this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. This makes the date of birth of the parent the determining factor.

The birthday rule has exceptions:

• If both parents were born on the same day, then the parent who has been covered by his or her plan longest will be the primary coverage for their children.
• If one spouse is covered through a current employer, then this spouse will have the primary coverage for the children.
• In the event of divorced or separated parents, then the parent with custody will generally provide primary coverage. If the custodial parent remarries, then the new spouse’s plan will be secondary. The non-custodial parent would provide a third layer of protection for the children/child.

Always keep in mind that these practices are very common among insurance companies, however, they aren’t governed by law. These sorts of practices may differ from one insurer to the other. Read your policy thoroughly to make sure that you fully comprehend how your insurance company will handle dual coverage for children. If you don’t understand what the policy says, ask for help from your employer’s benefit specialist or simply your insurer’s customer service department. I am pretty sure that they will gladly assist you and make sure that you understand your policy.