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birthday rule

What is the Birthday Rule for Health Insurance?

The birthday rule applies when a child is covered under both parents’ health plans. Primary coverage comes from the parent’s plan whose birthday (month and day only) comes first in the year, with the other parent’s health plan providing secondary coverage.

Let’s say Jennifer and Michael each have their own employer-sponsored health insurance, and they’ve opted to add their children to both plans. Jennifer’s birthday is July 20, and Michael’s is October 5.

Since Jennifer’s birthday comes first in the year, her plan will provide primary coverage for the children, and Michael’s will be secondary.

Although the birthday rule is the general standard, there are various situations where other procedures are followed in determining which policy is primary:

If both parents have the same birthday, the primary plan will be the one that has been in effect longer. Using the example above, let’s say they both had a July 20 birthday, but Michael’s plan has been active since 2010, while Jennifer has only been covered under her plan since 2020. In this case, Michael’s plan would be primary.

If the parents are divorced with joint custody, and a court has not specified which parent is responsible for providing health coverage, then the birthday rule would be used to determine which plan is primary if both parents maintain coverage for the child.

However, it’s common in a divorce for one parent to be responsible for maintaining coverage. In that scenario, that parent’s health plan would be primary, regardless of the parents’ birthdays.

If one parent is covered under COBRA or state continuation coverage and the other has active employee coverage (and the children are covered under both plans), the COBRA or state continuation plan will be secondary.

Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.