Secondary Insurance

What is “secondary insurance”? 

Secondary insurance refers to a health insurance plan that an individual has along with another health insurance plan. When an individual has two health insurance plans in place, one is assigned as the primary health insurance plan while the other one will be secondary insurance. For example, if a person is already covered by an employer’s health insurance plan but chooses to get another health insurance plan coverage, the latter will be the secondary insurance. 

Generally, health claims are submitted to the primary insurance first. The purpose of secondary insurance is to help and cover claims for medical care and services once the primary insurance is exhausted or cover what the primary insurance may not. 

When a person has two insurance plans, this does not translate to double payment or double reimbursement. The two health insurance providers work together to coordinate the benefits. Coordination of benefits is essential in determining payment responsibilities and in making sure that there is no duplication of benefits. 

What are examples of secondary insurance? 

Secondary insurance is sometimes referred to as supplemental insurance. There are many types or examples of secondary insurance. Here are some: 

• Vision: this is useful if a person’s primary insurance does not cover vision care
• Dental: a dental plan can cover routine, preventive, and other dental care treatments
• Critical care insurance, disability, cancer care, etc. 

Why is secondary insurance beneficial? 

Having secondary insurance is not compulsory. However, it is beneficial to have one in place especially when your primary insurance has covered everything that it can cover and there are more health claims needed.

 For example, let’s say that a person gets into an accident. The primary insurance has already covered most of the treatment and hospital care. However, the doctor prescribes more physical therapy sessions than what the primary insurance can cover. In this case, a secondary insurance plan can help with the additional physical therapy session coverage. 

Who can have secondary insurance? 

The following are examples of cases when secondary insurance is most common: 

• Adults under 26 years old who have a health plan through an employer but are still covered by the health plan of their parents. The employer insurance plan will be the primary insurance and the plan from their parents will be secondary insurance.
• Underage children where both parents have health insurance. When parents enroll their children in each of their insurance plans, the general practice is that the plan belonging to the parents whose birthday comes first in the calendar year is assigned as the primary insurance.
• Married adults or domestic partners who both have health insurance. In case both individuals in a marriage or domestic partnership have health insurance of their own, they can opt to make each other dependent on their health insurance plans. In this way, they can have their plan as primary insurance and their partner or spouse’s plan as secondary insurance. 

Is it possible to choose which insurance plan to use? 

No, a person does not have the flexibility to choose which plan to use first. When you receive health care treatment or service, the rule of thumb is that the primary insurance is billed first. This rule is upheld even if you think that your secondary insurance has better coverage than the primary insurance. 

As mentioned, only when the primary insurance has exhausted all that it can cover in terms of coverage can a person use secondary insurance. 

In this light, it is best to consider the following questions when getting secondary insurance:

• What does my primary insurance cover? 
• What kind of claims are outside of my primary insurance coverage?
• What additional coverage do I need?