Making a claim on health insurance is generally easy to do—but what if you have two policies? Through an employer, a spouse, or an individual plan, having two health insurances can be advantageous. But can you merge the two into a single claim? The short answer: no, but you can coordinate benefits and lower your out-of-pocket costs.
How dual health insurance works
When an individual is insured under two health insurance policies, the mechanism of "coordination of benefits" applies. This process identifies which insurance company pays first (the primary insurer) and which one pays second (the secondary insurer). The intention is to ensure that the combined payments of both insurers are not more than the cost of the medical care.
For example, if your primary employer's health plan is listed and your spouse's policy is secondary, you need to submit the claim to your primary insurer first. After the claim is processed and partially reimbursed (if applicable), you can then submit the remaining balance to your secondary insurer.
Can you file one combined claim?
No, you may not file one combined claim against both insurers. Both companies have their own claims procedure and regulations. You will need to finish the claim up with the primary company first. Once you do that, you can then submit a claim to the secondary company using the Explanation of Benefits (EOB) from the primary company. The secondary company will then consider what has already been paid and decide what further amount, if any, is covered.
What are the usual expenses covered?
Dual coverage tends to cut costs on co-pays, deductibles, and other out-of-pocket charges not entirely paid by the primary insurer. But if both policies share duplicate exclusions or identical deductible amounts, the benefit may be restricted. It's also worth mentioning that secondary insurers typically only pay what the primary does not, and won't cover you for more than the actual medical charge.
Key rules and exceptions
• No double-dipping: You can't claim an expense twice for a payment from both insurers, once.
• Birthday rule: In the case of dependent children who are covered by both parents, the "birthday rule" most commonly decides whose insurance is primary—the one who has the earlier birthday during the calendar year.
• Employer coordination: In the case of same-employer, same-group (e.g., employee and spouse work for the same employer), coordination can vary.
How to make the process smooth
Do not delay by not giving notice to both insurers that you are under dual coverage. Document every claim in great detail and have the bills itemized very clearly. Above all, do it in the right order—primary insurer first, then secondary.
Having two medical plans does not mean you will receive twice the reimbursement, but it can lower what you pay out-of-pocket. With effective coordination, you can take full advantage of your double coverage.
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