Friday, August 5, 2011

Can one person be covered under 2 diff. health insurance policies?

My employeer offers health insurance where the monthly cost is the same no matter how many family members you have on your plan. So I have our 2 children on my plan and my husband is on his plan through his employeer which provides the same type of plan-Can I add my husband to my plan and he add me to his plan? My thought is if something unforseen happens we would both be covered no matter what? But can you be enrolled on 2 different plans and if you are does that create complications when medical expenses are being submitted to your insurance?
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Yes, you can be covered by 2 insurances. Yours is primary for you-your husband's is primary for him. You and your husband's birth month and day determine who is primary for the kids. Whoever is born first in the calandar year is primary for the kids. EXAMPLE: Your birth month and day are April 6, your husband's is Sept. 20. Your insurance would be primary for the kids. (The year is not considered). But another thing you must consider is whether the insurances would PAY any additional benefits, and whether those benefits paid would offset the additional premium payments (if any) you would make for the coverage. Check the co-ordination of benefits clause in each to see how they co-ordinate benefits. Many times, there is a "no duplication" clause. Which means the second insurance will not pick automatically up a balance. The secondary insurance will compute its normal benefit and if the primary paid less, the secondary will pay the difference up to the secondary's maximum benefit. If you have an HMO, they (normally) will only pay benefits if the provider of service is one of their contracted providers and there is an authorization for the serivce provided. Therefore, it would not benefit you to pay the premium for the additional coverage unless you also jumped through all their hoops for payment. PPO's have many more contracted providers, but again you need to check with both coverages to see if they require certain authorizations or other documentation prior to the service being provided in order for any benefit to be paid. Most providers (doctors and such) bill both insurances at the same time and let them pay or deny charges based on who they consider to be primary or secondary following the rules I listed above. Once the primary has paid, the explantion of benefits needs to be forwarded to the secondary insurance for consideration. Some providers will do this for you, some do not. You will need to check with your providers to be sure.
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