All Blue Cross and Blue Shield of Kansas group contracts include a non-duplication of benefits provision. This provision applies whenever you or any member of your family is eligible for benefits from more than one group health care coverage plan. This does not apply to individual non-group health care coverage plans.
We have a list of guidelines to help us determine where the primary payment responsibility lies when duplicate coverage exists. Those guidelines are:
- If the patient is the insured named on the identification card, then that group coverage will be primary.
- If the patient is a dependent child, then the insurance carried by the parent whose birth date occurs earliest in the calendar year is normally primary. (Age is not a factor when working with the birth date rule.)
In cases involving separated or divorced parents, the following guidelines apply.
- If a judicial decree specifically designates one of the parents is responsible for the health care expenses of the children, then the insurance company covering the parent will be primary.
- If there is no judicial decree, the insurance company covering the parent with custody will be primary. If there is a stepparent with coverage in the child's home, the stepparent's coverage is secondary.
- If there is no judicial decree and the parent with custody is not covered by any group insurance, then any coverage which lists the other natural parent as a covered member is primary.
It is your responsibility to notify Blue Cross and Blue Shield of Kansas that you have duplicate coverage. If we are the secondary carrier, we will not make payment until we receive verification of what services the primary carrier has paid. You should also advise all your health care providers that you and/or your family members have duplicate coverage.
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