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There are several cases where individuals are covered under more than one health plan. For instance, they carry employer-provided group insurance along with an individual policy. So, which policy will pay in case of hospitalisation? Read this post to find out.
One of the most important considerations when purchasing a health policy is the coverage amount. Factors like your health, age, and medical inflation should be considered for selecting adequate coverage. The inadequate coverage amount is the biggest reason why a lot of people get covered under more than one health plan.
For instance, many employers in India now offer group insurance policies to their employees. But the cover of such plans is generally inadequate. So, such employees go ahead and then also purchase an individual plan with higher coverage. But if one such policyholder is hospitalised, which insurance provider will cover the hospital bills?
In other words, which will be the primary policy and which will be secondary? Let us have a detailed look at how this works-
What are Primary and Secondary Health Plans?
Individuals who are covered under two different health plans, like in the example discussed above, have a primary and secondary policy. In the case of hospitalisation, the primary plan will cover the medical bills.
The secondary policy will be activated if the coverage of the primary policy is not adequate to cover the bills. But note that both the plans will only cover the expenses up to the coverage limit.
How are Primary and Secondary Policies Determined?
The determination is done by the insurance providers, and policyholders do not get to make the decision. There is something known as Coordination of Benefits (COB) according to which the determination is done. In simple words, there are some rules based on which the primary and secondary policies are selected.
In case if you are covered under group insurance as well as an individual plan, it will mostly be your individual plan that will be your primary plan, and the group plan will be secondary.
What If You Are Covered by Two Group Plans?
A lot of group plans also cover the family members of the employees. So, for instance, if both the father and mother of a child are working and are covered under group plans which also provide coverage for the child, it is possible for the child to be covered under two group plans. So, which will be the primary policy in such case?
The Coordination of Benefits has specific rules for such scenarios. For example, the birthdate of the father and mother can be taken into consideration for selecting the primary health insurance policy. The policy of the parent that has the first birthday in a year, out of the two, will be considered the primary policy.
Alternatively, the primary policy selection can also be made based on who among the father and mother have been covered under their respective policies for a longer duration.
Finding Out Your Primary Health Plan
The Coordination of Benefits of different insurance providers has different rules for various scenarios. If you are covered by two health plans and want to know which among the two is primary, the best solution is to get in touch with both the insurance providers.
You can visit the insurance provider or also contact their support department online or offline to discuss the same. Only insurance providers can provide accurate information based on your specific case.
