Can A Child Be Covered by Both Parents’ Insurance?

Child Health Insurance Coverage 

A family floater policy is a type of health insurance that allows policyholders to add their children under the same cover. Each parent covered under their respective health insurance policies can add their children to it. The total sum insured is shared by every member covered under the policy. Although individual child health insurance policies offer a higher scope of coverage due to the separate sum insured, family floaters are priced lower and are therefore a more economical option. 

An important question that arises here is if it is feasible to have your child insured under both your and your husband’s insurance packages. It is important to address this question because if the child can only benefit from one parent, it makes no sense for the other parent to pay the extra premium for child coverage.  

Can a Child Benefit From Insurance Covers Of Both The Parents?

As mentioned earlier, both you and your husband can add your child to your health insurance packages, meaning that a child can enjoy the benefits of both insurance plans. If one plan falls short in covering certain advanced procedures, the other policy picks up on the remaining expenses. 

However, when a child is covered by both parents’ insurance, insurers employ a provision called the ‘Birthday Rule.’ This birthday rule allows insurers to coordinate the funds under each policy in a way that offers maximum coverage to the child. These funds are coordinated with the intent to ensure that claimants do not wrongfully earn more than the designated claim amount through multiple plans. 

Now, if your child is covered under two insurance plans, the birthday rule decides which shall act as primary coverage and which as secondary coverage. Let’s understand this rule in more detail. 

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Birthday Rule under Dual Insurance Coverage for Children

The birthday rule pertains to dual insurance covers that protect a single person. In the case of children that have coverage under two insurance plans belonging to each parent, the insurer applies this rule. It essentially splits the two plans into primary coverage and secondary coverage. The birthday rule acts as an unbiased procedure to determine coverage when a child is covered under both parents’ insurance. 

Key Aspects of the Birthday Rule

• The birthday rule determines the order of coverage for a child based on whose birthday comes sooner in the calendar year. Note that the year of birth or the age of the policyholder has no bearings on the birthday rule. 

• The parent whose birth date comes before in the calendar year is the one with the primary insurance coverage. The other parent’s insurance policy is designated as secondary coverage. For instance, if a parent’s birthday comes in March and the other’s is July, the insurance policy of the former will be the primary coverage.

• When a claim is made for the covered child, the primary insurance pays out the claim amount first. If the primary coverage was not sufficient to pay off all expenses, the secondary coverage comes in handy. 

• Even in cases where the parents are divorced, the birthday rule shall apply if the court does not specify the conditions themselves. 

Dual Coverage for Children under Different Scenarios

• In cases where a child is covered under a parent's policy and has also been added to the parent employee cover, the parent's policy will act as primary coverage. 

• In cases where both parents share the same birthday, the parent whose insurance has been in effect longer shall be designated as having primary coverage for the child.

• In cases where the parent with custody of the child has remarried and the child has been added to the new spouse’s insurance, the secondary coverage shall shift to the new spouse. 

• In cases where the child is covered under his/her employer cover as well as under the parents' cover, the employer coverage shall be primary. 

• In cases of a newborn child’s coverage, its delivery and standard care during the first 30-90 days are covered by the mother’s health insurance policy automatically. 

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Summing Up!

If you are a new parent, you should consider talking to your respective insurers about the coordination of benefits. Note that you cannot pick which policy shall be the primary source of coverage. While having two plans can be beneficial in covering all the expenses related to your child's treatment, these come with their restrictions. Every insurer has different standards and procedures in place that you should be aware of.  It has been seen that not being aware of how the birthday rule impacts a child’s coverage can cost a parent heavily.