Health Champion Blog

Double the Benefits

You’re married. You have jobs. And both employers provide health benefits. Double the insurance, double the benefits, right? Not so fast. And, while all the folks with little to no health insurance are likely reading this, saying, “I should have such a problem,” there really is a bit of Double Trouble when you have two sets of benefits under one roof.

The key to managing your coverage is understanding the rules, knowing which policy is your primary one and which is secondary (you don’t get to choose no matter how much you may like one plan over the other). However, you have to follow the rules of both, so pay attention to the details.

Some tips and reminders:

• When there are dependent children on both policies, most plans follow the birthday rule: the parent whose birthday month falls earlier in the calendar year holds the primary plan. The actual birth year is ignored.

• Make your doctor aware of all your health insurance coverage; always give copies of both cards.

• Ask if your doctor’s office will send the secondary carrier a copy of the bill along with an explanation of payment. If not, you’ll need to do that. This is critical to having the claim processed correctly.

• Using network/out of network providers: If your primary plan allows you to see both types of providers, but your secondary plan requires that you use only participating providers, the limitations of the secondary plan take precedence. In this case, the provider must be participating with the secondary plan. Otherwise, benefits won’t be paid.

• Ditto for preauthorization or precertification: the rules of the secondary health plan have to be met in order to process the claim.

Dual coverage is definitely a benefit, but it takes vigilance to ensure you don’t fall between the cracks of your coverage. When in doubt, call your plan administrators to learn what’s covered, what’s not and how to receive maximum benefits.

Next week, we’ll look at the Medicare Factor and see its impact on coverage.