| Home Health
Welfare - Coordinating Payments with Other Health
When your family
is covered by more that one health insurance plan, claims should be
submitted to the primary payor first. The Alaska Electrical Health & Welfare Plan is usually
the primary payor on the employee (participant) and the secondary
payor on the spouse.
“birthday rule” is applied when determining which plan is primary on covered
The health plan of the parent whose birthday falls earlier in the year is the
primary payor. In the case of covered step-children, the
natural parent's plan is primary and step-parent's plan is secondary,
regardless of birth dates.
When the Alaska
Electrical Health & Welfare Plan is the primary payor, submit your
claims in the usual fashion. If the Alaska Electrical Health &
Welfare Plan is not primary, you or your doctor should submit the claim to the other plan first. Once the primary plan
pays the claim and sends an Explanation of Benefits, you or your
doctor may submit a copy of the original claim, along with a copy of
the Explanation of Benefits, to the Administrative Office.
Benefit credits are earned when the Alaska
Electrical Health & Welfare Plan is secondary and your other insurance
plan pays for health services the Alaska Electrical Health & Welfare
Plan would have otherwise paid. Benefit credits may be used to
fulfill your deductible and out-of-pocket limits with the Alaska
Electrical Health & Welfare Plan. If you have already paid your
deductible and subsequently earn benefit credits, your deductible will
be refunded to you.