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How to determine your basic insurance so that both plans can be relied upon as one

Determine if the rule covers your situation. The “Birthday Rule” is used to determine which basic health insurance plan is basic if you rely on both plans, but it only applies to children.

  • If you are young, you can use the birthday rule to determine your basic health insurance plan.
  • This law may still apply if you are over 18, but you are a college student and you are still considered dependent on your parents.

Find out your parents’ birthdays. As its name suggests, the birthday rule compares the birthdays of each of your parents to determine your primary health insurance. The basic plan is the same plan for insured parents who have their first birthday each year.

  • For example, suppose you are listed as dependent on both your mother’s health insurance and your father’s health insurance. Your mother’s birthday is April 21, while your father’s birthday is December 1.
  • Under the birthday rule, your mother’s health insurance will be your primary plan using this example.
  • If both your parents have the same birthday, your primary health insurance plan is the one that has an effective date.
  • For example, if both of your parents were born on July 11, but have an effective history of your mother’s plan two years before your mother’s plan, then your mother’s plan is your primary plan.
  • Make an adjustment if your parents are divorced. If your parents are divorced or legally separated, your primary plan may not be related to the parents on their first birthday.
    • Generally, the parental policy that the court has ruled is responsible for your health insurance is your basic plan.
    • If there is no court decision regarding health insurance, your basic plan is to have a policy on which of your parents have primary care.
    • If the basic custody has not been determined, then the birthday rule applies.

Method 3 of 3: Using Coordination to Provide Benefits

View your health insurance policies. Coordination of benefits rules makes it easier to decide which health insurance plan is your primary plan. These rules only apply if both of your health insurance policies agree to provide benefits.

  • The same provision is adopted by almost all group health insurance providers, and applies to policies purchased by employers or unions for these employees or members.
  • Under a benefit delivery co-ordination, the plan nominated as a primary pays off all its benefits, and a secondary plan will save up to 100% of your healthcare costs.
  • If both of your plans involve the provision of benefits, you can use these principles to decide which plan is your primary plan.

Identify a plan that covers an active employee. Generally, if you only cover one of the plans that covers an active employee, then that plan is your core plan. Any plan that involves an inactive employee will be your second plan.

  • An example of a passive employee plan would be to cover a retired employee.
  • This part of the benefits principle coordination only works if only one of your plans covers an active employee.

Find out which project you have covered the longest. If the two projects on which you are listed as dependent core activists, then your basic plan is the one that covered you first. This is usually the effective policy history.

  • Important Date is the first date that you were added to the policy. If you have been listed as a dependent since the policy started, you will want to view the policy’s effective date.
  • However, in some cases, the date you will use will be the date on which you were added to the dependency policy.
  • You will need to find the appropriate date for each policy and then compare the two. First and foremost is your basic plan.

 

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