Jane Dotson
The birthday rule is a set of guidelines that insurance companies use to determine which insurance policy is primary and which is secondary when a child is covered by both parents' insurance plans. It is not a law, but most insurance companies follow it to ensure that insurance benefits are coordinated and not duplicated. The rule states that the parent whose birthday comes first in the calendar year provides the primary insurance coverage for the child. This rule applies in most states, but it is unclear whether it applies in Ohio.
| Characteristics | Values |
|---|---|
| What is the birthday rule? | A rule that determines which insurance company will pay first when a child is covered by both parents' insurance policies. |
| Who does it apply to? | Dependent children whose parents have separate insurance policies. It does not apply to adults, children on one parent's insurance plan, or children not listed on any parent's insurance plan. |
| Who created it? | The National Association of Insurance Commissioners (NAIC) |
| Is it a law? | No, it is a set of guidelines that most insurers follow. |
| What does it determine? | The order in which insurance companies will pay benefits. |
| How does it work? | The parent whose birthday comes first in the calendar year provides primary coverage, and the parent whose birthday comes later provides secondary coverage. |
| Are there any exceptions? | Yes, the birthday rule does not apply in cases of divorce or separation, blended families, or if one parent has an individual plan and the other has a group plan. A court order will always override the birthday rule. |
| Does it apply in Ohio? | The birthday rule is not state-specific, but it is a standard practice that most insurance companies follow. |
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What You'll Learn
The birthday rule and divorced parents
Divorce can be confusing, especially when children are involved. One of the many things divorced parents have to figure out is whose insurance will cover their child's medical expenses. Typically, when a couple has individual health insurance plans, the birthday rule applies. However, in the case of divorced parents, the birthday rule does not apply. Instead, the custodial parent's plan is considered primary, and if the custodial parent remarries, their new spouse's plan becomes secondary.
The birthday rule is a widely adopted rule used by insurers to coordinate the health benefits of dependents, usually children, who are listed on more than one plan. This rule helps insurance companies work together to avoid paying twice for the same service and ensures that children with dual coverage get the most from their insurance plans. While the birthday rule is not a nationwide law, it is a policy that most insurance companies follow, and nearly every state encourages its use.
According to the birthday rule, the insurance plan of the parent whose birthday falls first in the calendar year is considered the primary health insurance plan. It is important to note that the rule considers the month and day of the birthday, not the year. For example, if one parent's birthday is January 1, 1980, and the other parent's birthday is June 29, 1976, the insurance plan of the parent with the January birthday would be primary. The rule does not take into account the age of the parents.
In the case of divorced parents, the birthday rule does not determine the primary insurance coverage. Instead, the custodial parent's insurance plan is considered primary. If the custodial parent remarries and their new spouse has coverage, the new spouse's plan becomes secondary. This means that in the event of medical expenses for the child, the custodial parent's insurance plan will pay first, followed by the new spouse's plan, if applicable.
While the birthday rule does not apply to determining insurance coverage in the case of divorced parents, it is still important for divorced parents to consider their child's birthday celebrations and how they will handle them. It is recommended that divorced parents communicate and cooperate to create a positive experience for their child. This may include hosting a joint birthday party, alternating hosting duties in even and odd years, or finding a neutral location to reduce tension. It is also important to consider the guest list and whether the child's other parent and their significant other will be invited.
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The birthday rule and newborn coverage
The birthday rule is part of a set of rules called coordination of benefits (COB) that helps insurance companies decide which health policy pays for which service when a person is covered by more than one plan. The birthday rule is applied when a child has coverage under both parents' insurance policies. The rule determines which parent's coverage pays first and which pays second. The parent whose birthday comes first in the calendar year has the primary coverage for the child, and the plan of the parent with the later birthday is secondary. The birthday rule goes by month and day, not year.
The birthday rule also applies to newborns. Most insurance companies automatically provide newborn coverage for the first 30 days after birth. The birthday rule is applied when coordinating benefits if a newborn experiences medical complications. This can lead to higher out-of-pocket costs if the primary insurer offers lower benefits than the secondary one. In the case of the Kjelshus family, the birthday rule meant that the father's insurance plan, with a $12,000 deductible and high coinsurance obligation, was deemed primary coverage after their daughter's NICU stay as a newborn. The mother's more generous plan was considered secondary coverage.
Legislation has been proposed to address this issue, providing a 60-day period for parents to choose primary coverage and limiting the birthday rule's application. However, this bill has not become law. Expectant parents should proactively contact their insurance carriers to determine if the birthday rule applies and make informed decisions about their insurance plans.
It is important to note that the birthday rule only applies to dependent children and does not apply to adults. It also does not apply if a young adult is covered by both a parent's plan and an employer group plan, in which case the employer plan is primary.
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The birthday rule and dental insurance
The birthday rule is a set of guidelines that insurance companies use to determine which insurance plan is the primary plan and which is secondary when a child is covered by both parents' insurance policies. It applies to dependent children only and doesn't apply to adults or children listed on only one parent's health insurance plan. It is not a law, but most insurance companies follow it to ensure clarity and coordination of benefits across various policies.
The birthday rule for health insurance says that the parent whose birthday comes first in the calendar year provides the primary coverage for their dependent child, while the parent whose birthday comes later in the year provides secondary coverage. For example, if one parent's birthday is in March and the other's is in October, the parent with the March birthday will provide the primary coverage. The year of birth is not a factor in this decision.
The birthday rule also applies to dental insurance. It doesn't matter if the dental care is part of a health insurance policy or if it comes from a stand-alone dental plan. For example, if a child needs dental surgery and their primary insurance doesn't fully cover it, the secondary insurance plan will pay towards the balance of the bill, reducing out-of-pocket costs. However, it's important to note that neither insurance plan will pay for dental care it does not cover.
There are some exceptions to the birthday rule. For example, if both parents share the same birthday, the parent who has been covered by their plan for a longer period provides the primary coverage. Additionally, in cases of divorce or separation, the parent with primary custody of the child provides the primary healthcare coverage, regardless of their birthday. If one parent has an individual plan and the other has a group plan, the group plan is usually considered the primary plan.
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The birthday rule and joint custody
The birthday rule is part of a set of rules called coordination of benefits (COB). It helps insurance companies decide which health policy pays for which service when a person is covered by more than one plan. The rule applies to dependent children only and doesn’t apply to adults. It determines the order that the insurance companies will pay benefits when a child is covered by two health insurance plans. The birthday rule is applied when coordinating benefits if a newborn experiences medical complications.
The birthday rule usually comes into play for newborns when babies are covered by both parents' policies. The baby’s delivery and childbirth costs are automatically covered by the mother’s insurance policy. Usually, insurance companies automatically cover newborns for the first 30 days. The parents need to add a newborn to their insurance immediately after the 30-day period. If the newborn has dual coverage, both policies automatically cover the newborn for the first 30 days, and the birthday rule determines primary and secondary coverage.
The birthday rule decides which plan is primary when divorced parents have joint custody unless the judge decides otherwise. In cases where a parent with custody remarries and a child is added to the new spouse’s insurance, the biological parent with custody's insurance is primary. If one parent has insurance through an employer or the Affordable Care Act (ACA) marketplace and the other parent has COBRA or state continuation coverage, the employer or ACA policy is primary.
The birthday rule for health insurance says that coverage of the parent whose birthday comes earlier in the year pays first. The year each parent was born is not taken into consideration. For example, a parent with a March birthday would pay first, making it the primary coverage, if the other parent has an October birthday. When a child is covered by two parents' health insurance policies, the birthday rule decides which insurance company will pay first. This can affect your child's benefits because one parent may have better coverage than the other parent. It also impacts how much you pay for costs like copays, coinsurance and deductibles. With the birthday rule, one parent's coverage, called the "primary" insurance plan, pays first.
Joint custody of children refers to two types of custody, legal and physical. With legal custody, both parents have the legal authority to make decisions about a child’s welfare, schooling, religion, and healthcare. Physical custody is where the child is physically residing. Although joint custody relates to two types of custody, most parents are concerned about physical custody. In cases of joint custody, issues may arise regarding birthday parties and other special occasions. It is recommended that parents specify in their separation agreement that one parent can host a birthday party in odd years and the other in even years, if it’s important to them.
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The birthday rule and blended families
The birthday rule is a widely adopted method in the health insurance industry for determining the primary and secondary insurance coverage for dependent children of divorced or separated parents. It is not a law, but a set of guidelines created by the National Association of Insurance Commissioners (NAIC) to ensure that insurers do not overpay for services.
According to the birthday rule, the parent whose birthday comes first in a calendar year provides the primary insurance coverage for the child, while the parent whose birthday comes later in the year provides secondary coverage. The day and month of the parent's birthday are the determining factors, not the birth year. For example, if one parent's birthday is in April and the other's is in September, the parent with an April birthday will provide primary coverage.
In cases of divorce or separation, the plan of the parent with custody typically provides primary coverage, unless altered by a court-issued decree or agreement. This means that if a child lives with a custodial parent and a stepparent, the custodial parent's insurance is primary, regardless of the stepparent's birthday.
The birthday rule does not apply to adults, including step-parents or children in blended families. It is only relevant when a child is covered by both parents' separate insurance policies.
It is important to note that the birthday rule is not a nationwide law, and each state may have its own regulations regarding its application. While it helps establish the order of benefit payments, each insurance plan will still apply its own benefits and restrictions. Therefore, parents should carefully review their policies and consider consulting with insurance agents to understand their specific situations.
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Frequently asked questions
The birthday rule is a set of guidelines that insurance companies use to determine which insurance plan is primary and which is secondary when a child is covered by both parents' separate insurance plans.
The birthday rule states that the insurance plan of the parent whose birthday comes first in the calendar year is the primary insurance plan. The plan of the parent whose birthday comes later in the year is secondary.
No, the birthday rule does not apply if the parents are divorced or separated. In this case, the parent with primary custody provides primary healthcare coverage for the child.
No, the birthday rule does not apply to step-parents or children in blended families. In these cases, the custodial parent provides the primary insurance plan, regardless of birthday.
The birthday rule is not a law, but it is a standard practice followed by most insurance companies across the United States, including Ohio.
