Q What is the difference between primary and secondary health care coverage?
A Primary and secondary benefits coverage refers to the order in which insurance plans pay for your medical expenses when you have coverage under more than one plan.
Primary coverage: Is the insurance plan that pays first when you make a claim. If you have multiple insurance plans, the primary plan covers your expenses up to its limits or according to its policy terms.
Secondary coverage: Once the primary insurance has paid its share and if there are still remaining expenses, the secondary coverage kicks in. It covers applicable remaining costs that were not covered by the primary plan, up to its own limits or according to its policy terms.
In essence, primary coverage takes precedence over secondary coverage in paying for your medical expenses.
If yet another insurance is available, that would be considered tertiary coverage and would kick in after the secondary coverage has paid.
Instances where HBC coverage would be secondary:
· Other coverage is available
· Fail to qualify for primary coverage via the working spouse rule validation process
· Fail to enroll in Medicare in a timely manner
Find this FAQ and more under Resources at pnwhbc.org.