How Does Secondary Health Insurance Work?

Designating Primary and Secondary Providers

In some cases, the insurance you get through your employer will serve as your primary, while your spouse's coverage becomes your secondary health insurance. Another common method is to allot primary coverage based on which spouse has the earlier birth month.
Dependents are covered if both parents select family insurance. The insurers involved will determine which spouse has primary coverage, and which has secondary.

How to Obtain Secondary Health Insurance

To get secondary health insurance, your spouse must join a group health plan, and pay the premium for plus-one or family coverage. If your spouse elects individual coverage, you have no benefits under the plan. Likewise, to provide secondary health insurance through your health plan, you must choose to cover your spouse and dependents, and have them covered on your spouse's plan as well.

When Secondary Health Insurance Works

Every insurance plan spells out how the coverage will work with other health insurance plans. Check the certificate of coverage provided by both insurers for information on how each coordinates coverage.
In most cases, the primary insurer will pay standard benefits--the same benefits everyone gets. A secondary health insurer sometimes offers a higher level of benefits. It may pay more of the cost of care, or allow payment for services that are not available through first plan. In these cases, after the primary insurer has paid its standard benefits, your health provider may bill the secondary health insurer to see if it will cover the remaining costs.
Even with secondary health insurance plans, expect to pay co-payments and deductibles out of your own pocket.

Benefits of Secondary Health Insurance

If the primary insurer pays a lower percent of the cost than the secondary insurer would pay for the same service, the remaining amount can be submitted to the secondary health insurance plan.
Secondary health insurance provides an important benefit if you exceed the annual or lifetime maximum benefits for your primary insurance. This can happen during a long hospital stay or if a family member needs extensive mental health or addiction recovery services.

Considerations

Disclose all health insurance coverage you have to each of your insurers. Failing to do so can lead to fraud charges. Inform all of your health care providers when you have secondary health insurance. Claims for health treatment must go to the primary insurer first.