# adult 2 jobs 2 insurance who is primary?



## pbrown2012 (Jul 24, 2013)

What is the rules for an adult with 2 jobs and both have pt insured who is primary?


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## burtosh0 (Jul 24, 2013)

Under the birthday rule, the health plan of the parent whose birthday comes first in the calendar year is designated as the primary plan, according to the National Association of Insurance Commissioners. Note that it doesn't matter which parent is older, because the year of birth is not a factor. Thus, if your birthday is July 15, 1955, and your spouse's is Sept. 17, 1953, your health plan would be considered primary because your birthday comes first in the calendar year.

Reference: http://www.insure.com/articles/healthinsurance/birthday-rule.html


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## gkaufman (Jul 24, 2013)

Either of the insurance plans should be able to tell you which one is primary.  However, it is my experience that some plans do not coordinate and a patient can actually have more than 1 primary


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## mitchellde (Jul 24, 2013)

If a patient has 2 jobs and insurance with both then they have 2 primarys and you bill both insrances as a primary any over payments get refunded to the patient, this is not the same as a patient with insurance thru work and thru a spouse, that is when the birthday rule applies.  A patient is allowed to have as much health insurance as they can afford, so if the have group insurance thru 2 employers and the premiums are partially or totally paid by the employer, this is that patients benefits and if both pay as primary which is the way it should be, then any amount overpaid belongs to the patient since they paid the premiums for that coverage.


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## joecorinn (Jul 26, 2013)

I have not seen that the birthday rule applies to a patient with insurance through work and through a spouse.  The patient's insurance through work pays as primary and the insurance through the spouse pays as secondary.  The birthday rule only applies to a child who has insurance through both parents.


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## mitchellde (Jul 26, 2013)

joecorinn said:


> I have not seen that the birthday rule applies to a patient with insurance through work and through a spouse.  The patient's insurance through work pays as primary and the insurance through the spouse pays as secondary.  The birthday rule only applies to a child who has insurance through both parents.



OOPS yes you are correct, my bad!  I apologize.


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## teresabug (Jul 27, 2013)

If you are working and have insurance, yours is ALWAYS primary. You are thinking about the birthday rule which applies to DEPENDENTS (children/stepkids etc...) of the policy holder. Hope this helps!


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## Miller913 (Jul 30, 2013)

I've had this happen to me before. The patient had 2 jobs both with insurance (thru himself) & of course they both paid as primary & neither one of them wanted the refund. I finally was told by both the patient's HR & their insurance that one of the job's should be considered their "primary" job and that insurance would be the primary payer. Patient then had to update all information with his employers & the insurances. It was a mess to deal with!


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## mitchellde (Jul 30, 2013)

The refund goes to the patient since they are the paying the premiums .  There is information on the Internet for this situation.


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## alannae (Aug 7, 2013)

I don't know if this is the way it's supposed to work but...

I had a patient with two jobs both with insurance. After lots of communication and going back and forth, we ended up with the insurance for the 'oldest' employer being primary (he had worked for them longest) and the newer employer policy as secondary. The claims paid 100% and the patient was happy.


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## xlbctso (Aug 7, 2013)

Check with your State's legislative site for guidance.  Here in RI, our Dept of Business Regulations has the rules set out regarding primacy for group health plans and establishes the rules for primary vs secondary plans.  

The scenarios are:
(1) Dependent children - parents not separated or divorced
(2) Dependent children - parents separated or divorced
(3) Active/Inactive employee
(4) Longer/shorter length of coverage

If the individual in your situation is covered under their own insurance policy and that of their spouse, they are typically primary under their own coverage. (There may be caveats here if the individual is a retiree or has COBRA.)

If the individual has two jobs and has insurance with each job then the coverage in place the longest is primary.

If your individual has a mix of Medicare & Commercial there are rules around that as well, or Medicare with Medicaid, etc.


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## cyndeew (Sep 6, 2013)

It's called the longer/shorter rule. Whichever insurance has been in effect for the longest period is the primary.


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## cyndeew (Sep 6, 2013)

mitchellde said:


> The refund goes to the patient since they are the paying the premiums .  There is information on the Internet for this situation.



That is mostly not correct. You would use the longer/shorter rule. In the scenario given, it is health insurance through 2 employers so in most cases, they would follow NAIC guidelines. Not always, but most of the time.


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## risper61@gmail.com (Sep 24, 2013)

I'm going to do some research on this but I believe I remember from college primary is the employer you been working for the longest. I believe Alannae is right!


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## dclark7 (Sep 25, 2013)

Check with each carrier.  Most of the insurance providers will have coordiantion of benefits information on their website and this scenario should be addressed.  Most that I've seen use the longer/shorter rule (whoever has been insuring the patient the longest is primary).

However this only works if the patient has informed each insurance company that he has other coverage.  Many time the insurance companies have no idea that the patient has another policy.  If you call and this is the case request both insurance companies to send COB questionnaires to the patient.


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## wannabecoder (Sep 25, 2013)

If it is an adult who has the insurance for both plans, usually if they are both active group plans the plan that has been in effect longer is primary.  If its a group plan and an individual, medicaid, or tricare plan, then the group plan is primary.


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