I am going to have dual insurance coverage next year and I am trying to figure out which plan will be primary and which will be secondary.
My current plan is a self-funded plan which I have coverage through from my spouse’s work. The plan’s COB provision has very little information about order of payment. It only states “A plan that covers an individual as an employee is primary.” It mentions nothing about order of payment if you are a dependent on a plan.
The new plan will be paid for entirely by me. This plan has a robust COB provision that states that “… the Plan that covers the person as a dependent is the Secondary Health Plan.” However, it also states that “a Plan that does not contain a coordination of benefits provision that is consistent with this regulation is always primary unless the provisions of both Plans state that the complying plan is primary”.
So this is where my confusion is. The second plan says the plan that covers me as dependent plan is secondary, but it also says that a plan that does not contain a COB provision is consistent with this regulation is always primary. The first plan says nothing directly about being secondary if the plan member is covered as as dependent.
Any idea what would be primary and secondary in this situation? If its not clear, would the insurance companies settle this out between themselves? Do I need to notify both of them about the dual coverage? Or should I just bring both insurance cards to my doctor’s office and will their billing department sort it out?