Dual Health Insurance Coverage – Ever thought of getting an increased coverage and saving a lot of money on your health insurance costs? If yes, then the trick is to get covered by two health insurance plans. Does that sound impossible? It is not as complicated as it sounds. You can real advantages by getting hands-on two health insurance plans as you make claims. It will not only increase the coverage you will get but would also help you save a lot on your health insurance costs.
Health Insurance Plans and Its Benefits
An insurance that is covering the entire or some part of the possibility of a person undergoing medical expenses. An insurer assigned by the insurance company estimates the entire health risk of the person. And the expenses related to them over the pool of risk. He then develops a regular finance structure known as the payroll tax or monthly premium. This payroll tax or monthly premium is then provided to pay for the benefits related to health care which are specified in the agreement of the insurance policy. In most cases, the benefit packages given by the employer to its employees comprise Health insurance programs. This is a way of attracting efficient and qualified employees.
1dOften the health insurance programs provided by employers have the premiums partially paid by the employers but in some cases, these premiums are partially deducted from the paychecks of employees. The health insurance premium cost is deducted from the payer usually, while the benefits that he receives are tax-free. However, these health insurance plans can become very tricky when you are choosing them as they may have a lot of rules considering the in and out network services, co-pays, deductibles, etc.
The benefits of health insurance plans can be tempting
The benefits of health insurance plans can be tempting but when you are getting one, it can become really tricky. There are a lot of considerations involved in getting a good insurance plan. Usually, the managed care insurance plans have a requirement that the policyholders will be covered for the most expenses only if they get the care from a designated network of healthcare providers. However, if the policyholder or the patient wants to seek care from a health care provider that does not belong to the network designated by the insurance policy then they would have to pay a greater amount of the expense. There is also a possibility that the insurance company denies payment for health expenses if you seek healthcare services from healthcare providers that do not belong to the designated network.
Health Maintenance Organizations are such Managed Care plans
Point of Service Plans and, Health Maintenance Organizations are such Managed Care plans. These require their policyholders to select a physician for primary care who can check the patient, make suggestions regarding the treatment, and give referrals for specialists for their medical condition. However, A managed care plan known as Preferred Provider Organizations does not have this requirement but does have lesser rates for choosing network practitioners and their services. Before signing a health insurance policy, you must be aware that insurance companies in some cases also reject providing coverage for services that are received without getting authorization. In many cases, insurance companies could deny paying for drugs that are branded in a case where you could take a drug that is available at a lower rate.
Advantages of Getting a Health Insurance
Here are four major advantages of signing for a Health Insurance Plan:
- You can get a lot of tax benefits by purchasing health insurance plans.
- It will cover critical illness expenses such as stroke, kidney failure, loss of limbs, and bone marrow transplant. In case you get diagnosed with an illness on the list that is predetermined in your policy then you can get a good amount for the medical expenses. You can meet your daily expenses, financial obligations, and illness-related costs with this amount.
- It can provide you with a cashless claim facility so that you do not have to spend from your pockets. Any hospitalization expenses would be settled between the hospital and your insurer. To enjoy this facility, you just have to fill a pre-authorization form and show your health insurance card to the hospital.
- It can help you get the best health care without any trouble and financial burden. Your high medical costs will be covered such as daycare procedures, ambulance charges, hospitalization expenses, domiciliary expenses, etc.
What does having two health Insurance plans mean?
Signing for two health insurance plans means being eligible for the benefits of two health insurance policies. This process is known as the coordination of benefits. This simply means that an individual is covered by two health insurance plans and shall receive payments and payouts for health claims under both policies.
Let’s say if your spouse or partner has signed for family health insurance coverage and you are also covered by health insurance by your employer. You and your spouse both are covered under the health insurance policies and use the provision of coordination of benefits to increase your coverage for health care.
In many cases, two plans are better than one in providing coverage regarding a certain medical criterion such as mental health. Moreover, in another instance, one health insurance policy may have better coverage than the other. So, using coordination of benefits shall be a good idea.
How does having two Health Insurance Plans work?
As you have found out what does having two health insurance plans mean, you would be curious to find out how does it work. The process of coordination of benefits works when any one of the two health insurance policies is identified to be a primary health insurance plan. While the second policy is a secondary plan.
When you claim for insurance, the insurance policy which is your primary plan would be the first one to payout, and then whatever is the remaining cost, it will be paid by the secondary insurance policy. In case, that the primary plan was not able to cover it entirely.
The benefits of having one health insurance plan multiplied by two.
When you have a good health insurance plan, your life becomes much easier than for those who do not have one. Imagine if you have the benefits of having one health insurance plan multiplied by two. Would not it be something really to look up to?
Two health insurance policies would cover up your health insurance expenditure more effectively thanks to the coordination of benefits provision. Although, it may sound absurd to some of you as to why you are getting covered by two health insurance plans where one plan is already so expensive.
This concern is true no doubt, but some of people can get covered by two health insurance plans
This concern is true no doubt, but some of the people can get covered by two health insurance plans without spending and extra expenditure. A very good example of such a situation could be of two spouses or partners being covered by a health insurance plan and both are also covered by a health insurance plan provided by their employer individually. Now, when one partner is covered by a health insurance policy by their employer, their partner also gets covered in their health insurance plan. So the same applies vice versa.
Many people are concern about their medical data by not giving data as they have the fear that their data will be shared by the government, retailers, and Employers. Patients also withheld their information during visits which put patient’s health at risk.
HIPAA gives rights to a patient if they do not want to share the information. Until he/she allows to share. You can even file a complaint if your information is misused or improperly filed you can even ask the provider to correct it if incorrect information is provided.
Does it make sense to have dual health insurance coverage?
Getting Health Insurance is a good way to cover up all your surgical, medical, drug prescription, and dental expenses. In some cases, the health insurance can pay directly to the care provider and in other cases, it is reimbursed to the person insured. However, different types of health insurance are suitable for people based on their age, family history, etc.
When you sign for health insurance, all your visits to the doctor, emergency room trips, and treatments from specialists are paid for by the insurance company. It depends on which health insurance you choose. There are certain health insurances that cover hospital bills for big hospitals in case of surgery and major treatments.
The benefits of getting covered by two health insurance policies
However, imagine the benefits of getting covered by two health insurance policies. There are some circumstances, under which you shall opt for getting covered by two insurance plans:
- If you are a married couple or have a domestic partner and both are covered by a health insurance policy provided by the employer company.
- If you have children who are adults but are below the age of 26, who are covered by a health insurance policy by their employer or school and also by their parents.
- If you have a child who has 2 parents. Both have access to a health insurance policy and the child is covered under both of their plans and the parents think of including them in both health policies family benefits.
What harm can two insurance policies can do when you are getting covered for more expenses regarding health. And medical of you and your family. It totally makes sense if you are covered by two insurance policies. In order to better understand how these two will coincide with each other. You must talk to the health insurance provider and find out the tiny little details of how things will work and how you can get the best out of them.
The Coordination of Benefits System
When you have two health insurance plans, the providers have a provision under the name of coordination of benefits. This is a system that the health insurance plan providers seek. This system looks for a way for both the health insurance policies to play their fair part.
The coordination of benefits of both the health insurance plan providers checks the possibilities of the providers to merge both the health insurance policies in a way that duplication of benefits is avoided while they still can offer the coverage to the individual who is entitled to it.
The first step which is taken to coordinate the benefits
The first step which is taken to coordinate the benefits by the health insurance providers is to find out. Which health insurance policy of the individual or patient should be considered as the primary policy. And which one should be considered as the secondary policy.
These decisions are taken on the basis of some set guidelines. Which is based on the insurance providers and the state. These guidelines are set in order to help the insurance companies of the patients to choose. Which health insurance policy would be suitable to be the primary one. And which one should be considered as the secondary one.
The individual’s primary health insurance policy is determined
As soon as the individual’s primary health insurance policy determine. The patient is eligible for the benefits to cover under the primary health insurance policy. And these benefits shall be provided without thinking that there is another secondary plan.
This can also say that once the establishment of a primary health insurance plan is done. Then that policy would be responsible to pay for what it is liable to pay. Whether there is a secondary plan or not. Once a claim is settled by the primary policy, as determined by the coordination of benefits provision. Later the secondary health insurance policy will be used.
Unlike the primary health insurance policy. The secondary health insurance policy followed by the coordination of benefits takes the health insurance benefits into consideration. Which are provided to the policyholder in the primary plan. Whatever allowable cost of health care is remaining. It would consider being paid by the secondary health insurance policy.
Guidelines for the Coordination of Benefits System
As we discussed earlier, there are some guidelines to follow by the Coordination of Benefits system. And provided by the health insurance providers. These are the following to the insurance companies. So that an individual should be covered under this benefits system. And would still have to pay a part of the medical costs. This is not applicable to everyone. But there are areas where this is applicable. Such an area is the account of reasonable and customary.
Now, if even an individual has two health insurance policies. The insurance companies would follow the same guidelines regarding paying for their services. Most of the health insurance companies would only pay for the expense. That is customary or reasonable.
This is why when the primary insurance policy pays
It means that the health insurance company would not be spending on any supplies or services. Which are present in the receipt at a cost. That is greater than what the general charges are in the same area.
This is why when the primary insurance policy pays the amount that is customary and reasonable. There might still be a remaining amount. Which is shall be payable to the health care service in a situation. Where the health care provider is asking for more money. Then the primary health insurance policy thinks is customary or reasonable.
The secondary health insurance policy is not liable to pay the amount
On the other hand, the secondary health insurance policy is not liable to pay the amount. Which is remaining and is not paying by the primary health insurance policy. In this case, the patient or the individual is left to pay the remaining amount from their own pockets. Whether there are one health insurance policy or two health insurance policies. A cost of a service that is not including in any health insurance plans. And It would not be covered by any insurance plans. Neither primary nor secondary.
In case you have two health insurance policies or more. You must talk to the health insurance company which is providing you the policies. So that you can be sure of how the provision coordination of benefits works along with the two health insurance policies. And how you can get better health insurance coverage using the two.