Health Insurance Question

[Coffee Warlord]

Polling here first, because I don't really trust an insurance rep to advise anything other than "yes, spend more money with us!".

The deal:

Me and the woman both have Blue Cross insurance - hers is way, way better (one of the perks of being a teacher - badass insurance). And we're going to be abusing it quite soon with the forthcoming kid. Presently debating whether it's more cost-effective to put her on my insurance as well and use it as a secondary, or ditch mine and do everything on hers.

Yes, I know it's difficult to advise without knowing the coverage details, but I'm curious if anyone has been in a similar situation, and what they came up with for plots.

[JPhillips]

I've always been told that you'll have difficulties in assigning coverage if a single person is covered by two policies.

I'd PM lynchjm on this as he's in the industry.

[Swaggs]

You don't want to pay double premiums for the same coverage. If they are both issued by the same carrier (and provide the same coverages with the same deductibles and limits), go with whoever's premiums are less.

[lynchjm24]

Almost impossible that she'd need to be covered under two policies. If she's a teacher I highly doubt that is any gap in her plan that would ever result in a secondary plan paying a claim.

99.99999999% chance that your contributions would be wasted money.

And yes, there are logistical nightmares when someone has dual coverage as both plans try to make the other primary.

[Glengoyne]

If you're both covered under both policies, there will almost certainly be NO copays for either of you. Weigh that against the monthly premium cost.

With what could be a 20% copay or more looming with the birth, it could pay off.

[Glengoyne]

Originally Posted by lynchjm24

...

And yes, there are logistical nightmares when someone has dual coverage as both plans try to make the other primary.

There really shouldn't be any logistical nightmares.

You are each the primary member on your own policy.
Each of you will receive primary(first payer) coverage from your own respective plan, and each of you will receive secondary(second payer) coverage from your spouse's plan.

The primary insurance will pay as described in their benefit package, and the secondary payer will cover any copayments or coinsurance.

When joint dependents come into the picture, there is the well defined "birthday rule" to determine which parent's policy will provide primary coverage. The insurance policy of the parent whose birthday comes earliest in the year becomes primary coverage for the child.

[flere-imsaho]

lynchjm's post matches my experience, so I'd go with his advice.

Glengoyne might be right that you can use both and possibly save yourself some money, but I've seen people try to do this and it ends up in paperwork hell, especially if and when one of the companies tries to claim that a particular procedure should be covered by the other, or that you've run out of benefit with one company, etc.... Yes, all of it was sorted out eventually, but not after the people in question had spent hours and hours finding and faxing paperwork back-and-forth. You have to question if that level of effort is worth saving on some copays.

Especially when you both have the same provider and she simply just has the better plan.

[Chubby]

Originally Posted by Glengoyne

If you're both covered under both policies, there will almost certainly be NO copays for either of you. Weigh that against the monthly premium cost.

With what could be a 20% copay or more looming with the birth, it could pay off.

Huh? We didn't have any copay associated with the birth.

[Swaggs]

Although Glengoyne's scenario sounds nice, most policies (if you dig deep enough) have a provision that, for lack of better terms, passes the buck on to other carriers that you might have. Since both policies will almost certainly have this provision, they will go back and forth prolonging an already slow and laborsome process (and you will likely have to do a lot more legwork, as well). Essentially, neither carrier will want to have the title of primary insurer.

Also, being the primary insured (the person w/ the job that provides insurance) is different than being the primary carrier.

[flere-imsaho]

Originally Posted by Coffee Warlord

Yes, I know it's difficult to advise without knowing the coverage details, but I'm curious if anyone has been in a similar situation, and what they came up with for plots.

For what it's worth, here's my personal experience (and I have BCBSIL PPO, for what it's worth): four years ago the wife & I both got new jobs (at different companies). My insurance was far superior, so she went on mine - end of story. Two years ago we had Sam. Just prior to having Sam I reviewed the benefits for both plans again, to double-check that my insurance was still superior for the types of things we'd need it to cover. It was, so we didn't change things around.

With some money in a Flexible Spending Account to cover the stuff that isn't covered, we've paid very little out of pocket. Which is the other thing you might want to look at. This will probably be the first time you'll blow through your entire deductible and hit your "out-of-pocket limits" for certain types of care, so it can be pretty straightforward to calculate, up front, how much you'll be paying out of pocket.

[Glengoyne]

Originally Posted by Swaggs

Although Glengoyne's scenario sounds nice, most policies (if you dig deep enough) have a provision that, for lack of better terms, passes the buck on to other carriers that you might have. Since both policies will almost certainly have this provision, they will go back and forth prolonging an already slow and laborsome process (and you will likely have to do a lot more legwork, as well). Essentially, neither carrier will want to have the title of primary insurer.

Also, being the primary insured (the person w/ the job that provides insurance) is different than being the primary carrier.

I must really have had different experiences than most folks in this regard. Insurance companies are obligated to pay for claims for their members. I've never had any issues getting an insurer to pay their allotted amount. Or in determining primary or secondary coverage. Perhaps I've only dealt with reputable insurers like BCBS, who in Coffee's case would be insurer for both of them.

Professionally I've been part of projects where primary insurers are billed by secondary insurers who paid claims without the knowledge that a primary existed at the time of the service, and those primary insurers have paid their portion of those claims in full even years after the fact. This is a contractual obligation for the insurers, and especially for routine coverage issues like we're discussing here, I don't see why there would be any resistance to payment.

[Glengoyne]

Originally Posted by Chubby

Huh? We didn't have any copay associated with the birth.

Depends on the policy. Some would have an 80/20 or 70/30 coinsurance or copayment for inpatient services. Meaning the insurer pays 80%, and the member is responsible for the balance.

In our case this was an 80/20 breakdown. My wife's insurance paid the 80%, and we received a bill(actually bills) for the balance. We passed those on to my insurance where those were paid. I can't recall specifically how the childrens' bills were handled.