What Is the Health Insurance Birthday Rule in the United States?

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How does the birthday rule apply to insurance in the United States? When a child is insured by both parents’ health policies, the birthday rule applies. Primary coverage is provided by the health plan of the parent whose birthday (month and day only) falls first in the calendar year, with secondary coverage provided by the other parent’s health plan.

Let’s assume Amanda and Elon each have their own employer-sponsored health insurance and have chosen to enroll their children in both. Elon’s birthday is November 5 and Amanda’s is August 20.

Because Amanda’s birthday is the beginning of the year (it makes no difference how old they are; the birth year is irrelevant), her plan will provide primary coverage for the kids, while Elon’s will provide secondary coverage.

What Is the Birthday Rule for Coordination of Insurance Benefits?

The birthday rule is part of the National Association of Insurance Commissioners‘ long-standing model legislation. Different techniques can be used by states and insurers, but most have accepted the birthday rule as a standard, unbiased method of identifying primary and secondary coverage in cases where a kid is covered under both parents’ insurance.

Although the birthday rule is the general rule, there are a number of scenarios in which additional techniques are used to determine which policy is the most important:

If both parents have a birthday, the primary plan will be the one that has been in force for the longest. So, if Amanda and Elon both turned 20 on August 20, but Elon had been insured under his plan since 2006 while Amanda had only been covered since 2014, Elon’s plan would be primary.

Beyond signing up a child under the parent’s health insurance plan, you can also get any of these types of child life insurance plans to save money for the future.


How Does the Birthday Rule Work When Parents of the Child Are Divorced?

How Does the Birthday Rule Work When Parents of the Child Are Divorced

If the parents are divorced and have joint custody, and the court has not specified which parent is responsible for providing health care for the children, the birthday rule will be utilized to establish which plan is primary if both parents have coverage. 

However, it’s usually for one parent to be responsible for continuing coverage after a divorce. In that case, regardless of the parent’s birthdays, that parent’s health plan would take precedence. We recommend you also read about how life insurance works during a divorce in the United States.

If the custodial parent remarries and the new spouse has their own health insurance plan to which the child is added, the new spouse’s coverage becomes secondary, with the non-custodial parent’s coverage acting as a third line of coverage, only covering charges not covered by the primary or secondary plans.

What Are the Rules for COBRA Insurance?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) or state continuation plan will be secondary if one parent has COBRA or state continuation coverage and the other has active employee coverage (and the children are covered under both plans). On average, the monthly COBRA premium cost is $400 – 700 per person. 

If a young adult is covered by both a parent’s and a spouse’s plan, the plan that covers them for the longest period of time will usually be primary. However, if both plans’ coverage began on the same day, the birthday rule would apply.

To determine which comes first in the year, the insurers would look at the parent’s birthday (or both parents’ birthdays if the person has coverage under two parents’ policies in addition to a spouse’s plan) and the spouse’s birthday. The policy that is tied to the individual with the earliest birth date would be the most important.

If a young adult has coverage under both their parents and their own employer’s health plans, their own employer’s plan will take precedence, and the birthday rule will not apply.


Coverage for a New Dependent is Automatic

Most health insurance policies are required to cover a new dependent (newborn or newly adopted child) immediately at first, but you’ll need to request that the child be added to your policy (within 30 to 60 days, depending on the plan) to continue coverage.

Although some states have set their own rules for coverage for new dependents, this is part of another model statute.

Editorial Team
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