Primary and Secondary Travel Insurance Coverage (2024)

FAQs

Does it matter if travel insurance is primary or secondary? ›

There is no difference in what is covered or excluded; Secondary policies just require an extra step when filing a claim. Primary travel insurance policies allow a traveler to file a medical claim directly with their travel insurance provider, without contacting their health insurance provider at all.

The Birthday Rule

Example: Patient's mother's birthday is October 11, and patient's father's birthday is April 24. In this case, the father's insurance would be the primary insurance and the mother's insurance would be the secondary.

For example, if an individual has health insurance through their employer, that would typically be their primary insurance. If their spouse also has health insurance through their employer, that would be the secondary insurance.

There are some situations where having two health insurance plans can help you reduce your out-of-pocket expenses. For example, if you have two health insurance plans that cover different areas of your medical needs, then one policy may cover one area while another policy covers the other area.

A credit balance results when the secondary payer allows and pays a higher amount than the primary insurance carrier. This credit balance is not actually an overpayment. The amount contractually adjusted off from the primary insurance carrier was more than needed, based on the secondary insurance carrier's payment.

Double the Fixed Costs

Two health insurance plans mean paying two premiums and deductibles. This situation means a greater monthly cost for premiums and a higher out-of-pocket cost to satisfy the deductible limit for each plan.

Is Secondary Insurance Worth It? Secondary health insurance can help reduce out-of-pocket costs, but having multiple health plans isn't always a great situation. Paying two premiums and deductibles and juggling two provider networks and health plan benefits may be costly and a health insurance headache.

Your primary plan processes the insurance claim first and covers the bill up to its coverage limits. If your primary insurance is unable to cover the entire claim, your secondary insurance may cover all or a portion of the remaining costs.

The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer.

The most common dual-coverage situation is one in which someone is covered by two medical insurance plans. It's also possible to have two dental plans or two vision plans if an employee is covered by their plan and also their spouse's.

When would a bill for secondary insurance coverage be created? ›

When Can You Bill Secondary Insurance Claims? You can submit a claim to secondary insurance once you've billed the primary insurance and received payment (remittance). It's important to remember you can't bill both primary and secondary insurance at the same time.

Each type of coverage is called a “payer .” When there's more than one payer, “coordination of benefits” rules decide who pays first . The “primary payer” pays what it owes on your bills first, then you or your health care provider sends the rest to the “secondary payer” (supplemental payer) to pay .

Primary insurance pays first for your medical bills. Secondary insurance pays after your primary insurance. Usually, secondary insurance pays some or all of the costs left after the primary insurer has paid (e.g., deductibles, copayments, coinsurances).

Secondary insurance plans work along with your primary medical plan to help cover gaps in cost, services, or both. Supplemental health plans like vision, dental, and cancer insurance can provide coverage for care and services not typically covered under your medical plan.

Primary payers are those that have the primary responsibility for paying a claim. Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. Medicare is also the primary payer in certain instances, provided several conditions are met.

Travel medical insurance can be primary or secondary coverage, depending on the plan. If it's primary, it will pay out before any other health insurance you have. If you have health insurance and buy travel medical insurance as secondary coverage, your own health plan must pay first.

Definition: Primary insurance coverage refers to priority of payment when you file a claim. If you purchase a travel insurance plan with primary emergency medical and dental benefits, that means the travel insurance company is the first payer or reimburser of those benefits.

To determine which plan is primary, which means the insurer pays for covered services first according to the benefits provided by the plan. The other insurer pays secondary, which means it pays the remaining unpaid balance according to the benefits provided by its plan.

Coordination of benefits decides which plan pays first (the primary plan) and which pays second (the secondary plan). Sometimes, a state or the federal government may set up the COB regulations. Large employer group plans create their own COB rules, too.