What Is The Definition Of Tertiary Insurance?

Tertiary Insurance

Tertiary means 3rd in terms of the order, level, or number. So when we are talking about insurance policies, tertiary insurance means it is not primary or secondary insurance. This type of insurance can only be claimed after primary and secondary benefits are claimed. Usually, tertiary insurance is offered to employees along with their basic individual and family health insurance.

Key Takeaways

  • Tertiary Insurance is a type of insurance and it basically supplements existing insurance policies
  • The tertiary insurance can only be claimed after the benefits from the primary and the secondary insurance have been exhausted
  • You can get tertiary insurance from the credit card issuer, bank, or other companies
  • You can easily update the information on tertiary insurance in the secondary insurance section

What Is Tertiary Insurance?

Tertiary insurance is a type of insurance that supplements existing insurance policies. In fact, tertiary insurance is a third insurance policy that you can have after your Medicare and a supplemental policy. Tertiary insurance can be the result of having health insurance from multiple places. For example, one spouse works for a company and gets health insurance while another spouse used to work for another company and gets retiree health insurance from the former employee and then joins another company and receives new health insurance. Having more than one policy is sometimes beneficial because one insurance policy might cover an expense that another one might not. Usually, primary insurance covers all costs under its policy limits and secondary insurance would cover the extra costs. However, for any reason, if the primary insurance doesn’t cover these costs then the tertiary insurance will cover these claims.

Getting Tertiary Insurance

The tertiary insurance can only be claimed after the benefits from the primary and the secondary insurance have been exhausted. Therefore, the premiums for tertiary insurance can be low compared to the premiums for primary insurance. Many companies offer tertiary insurance as a part of a compensation package. You can also get tertiary insurance from the credit card issuer, bank, or other companies that might add an insurance protection plan as part of its package.

How Tertiary Insurance Works

A tertiary insurance policy can only be in use if the primary and secondary policies are not adequate. For example, if you have a claim of $150,000 and your primary and secondary insurance only covers $100,000 then the tertiary insurance policy will kicks in. So when you have three policies, the primary insurer will always be billed first. After that, if there is any balance left then that balance goes to the secondary insurer. Finally, if there is any balance left then it will go to the tertiary insurer.

Importance Of Tertiary Insurance

Many people consider tertiary insurance unnecessary because most of the time the primary and secondary policies provide more than enough coverage. But you have to understand that insurance won’t cover all the incidents. There will always be exclusions or low coverage amounts therefore, the two insurances might not be sufficient enough to pay for your claim. Therefore, in this type of situation, tertiary insurance can come very handy.

FAQs About Tertiary Insurance

1. What Does Tertiary Payer Mean?

When a beneficiary has more than one primary insurer then Medicare becomes the tertiary payer. It’s always the responsibility of a primary payer to pay the claims first. 

2. What Is It Called When Medicare Forwards A Claim To The Secondary Insurance?

When Medicare forwards a claim to the secondary insurance it is called the secondary payer. If the primary payer didn’t cover the claims then the secondary payer will pay the claims. 

3. How Do You Bill A Tertiary Claim?                                

There are many ways you can bill a tertiary claim. They are:

1. You can update the information of tertiary insurance in the secondary insurance section and then can bill it as a secondary to the tertiary payer.
2. You can also drop the claim on paper and then bill it through postal mail.

4. How Are Primary And Secondary Insurance Determined?

The insurance that pays the claim first is known as the primary insurance and the plan will pay up to coverage limits. Once the primary insurance paid the full claim then the rest of the claims go to your secondary insurance.

5. How Do I Bill Medicare Tertiary Claims?

If you want to claim the Medicare tertiary claims then follow the below steps:

1. You have to submit the claim electronically as Medicare primary
2. If your claim is denied then you have to submit a completed form and include both primary payers’ Remittance Advice (RAs)

6. Do Providers Require Bill Secondary Insurance?

If the physician has the information of the secondary insurer then he/she must submit the bill. If the physician does not have the required information then he/she should give the patient a copy of the bill so that the patient can submit it for reimbursement.

7. What Is The Primary Goal Of Tertiary Care?

Usually, the medical service is divided into primary, secondary, and tertiary care. Primary care only focuses on general care while secondary and tertiary care mostly focuses on severe conditions that require specialized and more intensive health monitoring.

8. Can You Be Covered By 2 Insurances?

Yes, you can be covered by 2 insurances. For example, you can have two health insurance plans and it is perfectly legal. Under certain circumstances, you can have multiple insurance policies.

9. How Do You Determine Which Insurance Is Primary And Which Is Secondary?

Determining which insurance is primary and which is secondary is very easy. If you have an insurance policy from your employer and another from your spouse’s or parent’s plan then your own plan will be primary and the other plan will be the secondary plan.

10. Does Secondary Insurance Pay The Primary Deductible?

Yes, secondary insurance pays the primary deductible. Usually, secondary insurance pays the costs that are left after the primary insurer has paid the claim.

11. Is Medicare My Primary Or Secondary Insurance?

Medicare is your primary insurance and your providers must submit claims to Medicare first. In this type of situation, your retiree coverage will be considered as a secondary policy.

12. Is It Worth Having Two Health Insurances?

It is always considered beneficial to have two health insurance policies. Two health insurances can increase your coverage limit and also save money on your health insurance costs.

13. What Happens If You Don’t Sign Up For Medicare Part B At 65?

Medicare part B starts at the age of 65 and if you don’t sign up for Medicare part B then you’ll have to pay a 10 percent surcharge on your Medicare Part B premiums for each year.


1. https://www.sapling.com/5262777/tertiary-insurance-definition
2. https://budgeting.thenest.com/tertiary-insurance-definition-32989.html

Last Updated on October 24, 2022 by Magalie D.

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