Covered by two health insurance plans?

Question

My girlfriend just graduated from college, but she is covered under student health insurance until August of 2007. She just got a job, which gives her free health insurance from Aetna, which means for about 7 months she's going to have two health insurance plans. My question is, is there a way to have it so that one insurance company pays their responsibility, say, the 80% of the medical bill, and then the other company pays the 20% that would be your copayment, so that you end up paying nothing between the two of them? If not, then what is the benefit of having two insurance plans, if there is one.

Thanks

Answer 1

Most of hte time, each policy has a clause in it about sharing coverage with two or more policies. Unless one of the coverages is medicare, usually they pay on a "pro rata" basis, so you still end up with your copays and coinsurance.

Which menas, there's no benefit from having two plans in place.

Answer 2

Oh my... Ok. Here's the deal... There's an organization called the National Association of Insurance Commissioners. They set a standard, that most insurance companies follow... Its not a law, just a rule of thumb... Aetna will be primary, because its her active plan.

Here's the fun part... There's more than one way to coordinate/calculate benefits. You need to call her student insurance, and ask them if they will coordinate. Because its a student plan, they work a little differently than group health insurance... (They may flat out tell you no) Step two: If they will coordinate, ask them how they coordinate... There are 3 possibilities... Do they pay everything the primary insurance does not; meaning you pay $0.00.
Do they only pay up to what they normally pay; meaning you still have to pay what you would normally pay with only your student insurance?
Or, the least likely thing, Do they pay you a benefit credit?

Unless its a really nice student insurance policy, she should probably drop it as soon as the group health starts...

Ultimately, the answer to your question is... no. There is not a way to force the carriers to allow you to have $0.00 responsibility... But, it is possible that it will work out that way. Some people have 2 insurance plans, and never pay anything to a doctor or hospital... Others, never see the benefit of having 2 plans... Its all up to your secondary plan, and how much or if they pay. Good luck.

Answer 3

As the other answerers mentioned, this involves a matter referred to as "Coordination of Benefits." Most (but not all) health policies will have this provision.

Here's the bad news: in order to conclusively know the answer to your question, you or your gf will have to brew some strong coffee (to ward off sleepiness due to boredom) and read the COB provisions of BOTH policies. Some secondary plans will pick up the remainder of the bill (including co-pays) after the primary pays, and some won't. There's just no general rule of thumb, since policies work differently. Whether the health care provider is participating with one or both plans will also affect how both pay. And finally, the service that's rendered may be covered under one policy and excluded under the other.

p.s. "Zippythejessi"-- the Birthday rule is only used when determining which parent's plan is primary when both mother and father cover the same child; it's never used when determining COB for adults. A person's primary insurer is ALWAYS the insurer who covers them as subscriber; the secondary is ALWAYS the insurer that covers them as dependent.

Answer 4

In this case, there is no benefit to two plans. The issue becomes what is called "Coordination of Benefits" - meaning that these two plans are going to point fingers at each other and say "That plan is responsible - not us". So, she really needs to cancel the student health insurance if she can. Otherwise, EVERY claim that is filed by a provider is going to run into this problem.

The situation you're describing CAN happen - if there are two separate plans with two different people - such as a wife also being covered under her husband's insurance. (which is not the case you described.) Then, the "birthday rule" comes into play - meaning whomever's birthday comes first in the year (regardless of who is chronologically older) would hold the primary insurance and the other spouse's plan would be secondary. Some providers are able to bill the secondary plan, but in many cases, the patient has to pay their portion (i.e. copay, etc.) and then submit the receipt to the secondary insurance and get reimbursed by the secondary plan.

Answer 5

Here http://wiz.sc/Ifp4G2 is an article i found on health insurance with information and tips etc. Hope it helps.

Answer 6

Double Indemnity - Means being paid twice for the same claim. Its illegal.