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  1. #1
    Join Date
    Sep 2019
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    Default Primary vs Secondary Health Insurance

    My question involves insurance law for the state of: California
    My 24 year old daughter has dual health insurance. Her primary is Kaiser Permanente through her employer and her secondary is PHCS through my husband. She wants to have a baby but does not want to use Kaiser she wants to go to her own OB/GYN that delivered her first child. Can she use the secondary instead of the primary?

  2. #2
    Join Date
    Oct 2006
    Posts
    15,683

    Default Re: Primary vs Secondary Health Insurance

    Quote Quoting maryrkr
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    My question involves insurance law for the state of: California
    My 24 year old daughter has dual health insurance. Her primary is Kaiser Permanente through her employer and her secondary is PHCS through my husband. She wants to have a baby but does not want to use Kaiser she wants to go to her own OB/GYN that delivered her first child. Can she use the secondary instead of the primary?
    I don't think that she can if she wants to be covered by insurance. I think that the secondary would object to providing primary coverage. This is not an emergency situation. However, you can certainly contact the secondary insurance to see if they would cover it.

  3. #3
    Join Date
    Jul 2018
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    1,756

    Default Re: Primary vs Secondary Health Insurance

    Depends entirely on the terms of the policy. She understands that she can decline her employer's insurance coverage, right?

  4. #4
    Join Date
    Jan 2006
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    38,734

    Default Re: Primary vs Secondary Health Insurance

    Quote Quoting pg1067
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    Depends entirely on the terms of the policy. She understands that she can decline her employer's insurance coverage, right?
    At least sometimes that is not true. In fact in my situation it is mandatory my wife or my children would be required not only accept if free but purchase their employers insurance or my insurance would deny them coverage altogether. Then their own insurance would be primary and mine secondary. I agree with the first part of your response though.

  5. #5
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,106

    Default Re: Primary vs Secondary Health Insurance

    If she has two coverages she MUST use the primary one first and the secondary one second; she does not have the option of bypassing the primary and going straight to the secondary. I have worked with employer sponsored coverage for 40 years and have yet to see a situation that will allow you to bypass the primary in favor of the secondary. At the very least, she would have to submit to the primary and get a denial; then submit the denial with the rest of the paperwork to the secondary policy. If she wants to use the secondary policy solely, she needs to drop the primary coverage.

  6. #6
    Join Date
    Jan 2006
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    38,734

    Default Re: Primary vs Secondary Health Insurance

    Quote Quoting cbg
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    If she wants to use the secondary policy solely, she needs to drop the primary coverage.
    again, if the secondary policy provider allows for that.


    As I stated, in my personal situation, my employer provided insurance demands anybody on my policy such as my wife or adult child, must carry the policy provided by their own employer (there are a few exceptions Allowed). If they fail to purchase the insurance available to them through their employer (which automatically makes their policy primary), they will not be covered at all under my policy. It may be a very unique situation (I really do not know if it is). That is why page1067 advice to speak with the parents policy administrator about the situation.

  7. #7
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,106

    Default Re: Primary vs Secondary Health Insurance

    Yes, on that I will agree with you that the policy rules. But since that issue had already been addressed, I didn't repeat it.

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