If an individual is covered by both their policy and their spouse's policy, which policy is responsible for payment in the event of an illness?

In situations where an individual is covered by both their own insurance policy and their spouse's insurance policy, the individual's own policy typically pays first. This principle is rooted in the concept of "primary" and "secondary" coverage. The primary insurance is the one that pays first, covering the costs up to the limit of the policy, while the secondary insurance may cover any remaining costs, depending on the terms of both policies.

This order of payment is generally standard in many insurance practices to ensure that claims are processed efficiently. The rationale is that individuals have a personal stake and direct involvement in their own policy, which makes it the primary source of coverage for any medical expenses incurred. Once the primary policy has settled the claim, the secondary policy may then address any additional costs above the primary policy's limit, subject to its own coverage terms.

Understanding this hierarchy of coverage is crucial for policyholders to manage their healthcare expenses effectively and determine which policy to utilize first in the event of an illness.