Question

should the gender rule be used to determine primary insurance for dependent children? why and why not​

Answer 1

Sure that you understand how your benefit coverage works when you have multiple insurances.

A few simple guidelines to assure maximum benefit are:

Scenario Explanation
If you have other insurance, then … Highmark sends you a Coordination of Benefits (COB) questionnaire to determine which plan is primary
If services are rendered to you, and you are the employee under the plan, then… Your plan through your employer is the primary plan for you.
If services are rendered to your spouse, who has a policy through another insurance carrier, then… Your spouse's own policy is the primary plan for your spouse.
If services are rendered to a dependent, who is covered by both parents' policies and both policies have the birthday rule, then… Coverage for the parent whose birthday falls earliest in the year (month and day) is the primary plan.
If services are rendered to a dependent who is covered by both parents' policies and both policies have the birthday rule and both parents are born on the same month and day, then… The primary plan is the policy that covered the patient for the longest period of time.
If one insurance company follows the birthday rule and other follows the gender rule, then… The policy with the gender rule dictates the father's coverage to be the primary plan.
If parents are divorced and there is a court order stating which parent is primary, then… The policy of the parent listed on the court order is the primary plan.
If parents are divorced and no court order, then… The parent with custody is the primary plan.
If parents are divorced and parent with custody remarried, then… The plan of the stepparent with custody is primary over the natural parent without custody.