What to do if you have more than one health insurance policy

It is not unusual for a person to obtain medical coverage under many health insurance policies.

For example, spouses may have coverage for themselves and some of their employers. Older employees may have health care and employer-sponsored coverage, and retired employees may have insurance coverage and health care sponsored by the retired employer.

However, understanding the policy behind any claim can be difficult.

Multiple health insurance policies can create a paper and logistical nightmare for both insurance companies and policyholders. However, multiple policies can provide inconvenient benefits.

Below is a basic summary of how multiple health insurance policies work together.

Let's say, for example, that you end up in the hospital with a broken arm. It is covered with two health insurance policies. What You Pay When it comes to group health insurance plans, this call is made using an industry standard called "Coordination of Benefits" (COB).

The primary purpose of the COB Guidelines is to ensure that individuals do not derive financial benefits from duplicate health coverage, while ensuring that all personal and medical expenses are covered whenever possible.

In general, one health insurance policy is defined as the primary plan and the other as the secondary plan.

The basic plan pays all of its benefits, while any secondary plan pays additional qualifying benefits after the basic plan benefits are exhausted. Patients can get 100% of the benefits from medical bills, but not more.

What is the plan that works as the basic plan that varies depending on the type of coverage and the situation? Group and individual insurance, Medicare and Medicaid are played according to different rules. In general, insurance providers operate under the following rules:

Group Health Plans: Group health insurance plans that do not include COB allowances will always be the basic plan.

Non-member vs. member: A group plan that covers you as an employee or member generally pays before the plan covers you as a dependent.

Active vs. Inactive: Any group health insurance policy that covers you as an active paid employee before the coverage document as a former employee.

Dependent children: If the child's parents are listed as dependents in their group insurance policies, some companies use the so-called "Christmas rule". The plan for a parent whose birthday is already in the calendar year is the plan you pay for. If both parents had the same birthday, the longest valid plan would become the basic plan.

Individual Health Plans - The above rules apply to group coverage. When it comes to individual health insurance plans, COB does not apply. In general, individual health plans pay all of their benefits regardless of other group health policies. However, many of these policies have their own provisions regarding multiple insurance plans, so it is important for policyholders to read their policies.

Medicare / Medicaid: Medicaid is always the last insured resource. Therefore, if you have other plans, you will almost always pay before starting Medicaid.

When it comes to Medicare, things get complicated. The plan that pays first may be affected by the status of the job, the size of the employer, and the nature of other insurance coverage. There are even separate rules governing coverage for kidney disease at the end of the stage.