How do you coordinate benefits for deductible plans

by vfarnum » Tue Apr 23, 2013 03:14 am

I am insured under my group plan and also have secondary insurance under my husband. Both plans are HDHP (high deductible plans) of $1,500 per individual, which I have not met. I have a specialist bill of $120. I would like to know if both plans will apply the bill toward my deductible? My understanding is $120 will be applied to the deductible of my primary insurance. Once I satisfy $1,500 from my primary insurance, my co-insurance of 80/20 will apply. The 20% co-insurance will then be applied to my secondary deductible until satisfied. Is this right?

Total Comments: 4

Posted: Mon May 06, 2013 10:14 pm Post Subject:

Depends. You need to look at both contracts to see if they contain a "coordination of benefits" provision, which is likely. If that's the case, then your group plan will pay as primary and coverage under your husband's group plan would be considered "secondary" or excess insurance.

If there are no coordination of benefits provisions, you'll have to look at the contract specifically to see which company will pay what.

I'm assuming that they're both group plans?

InsTeacher 8)

Posted: Wed May 08, 2013 02:21 am Post Subject: Deductible coordination

Assuming both group contracts contain coordination of benefits and the charge is a covered visit and the deductible on both plans have not been satisfied, Will the bill be applied to the deductible of the primary, leaving no charge or expense on the secondary insurance? Does this mean the secondary insurance will not be utilized until the deductible of the primary is satisfied or the charge is not covered? Can you give an example?

Posted: Thu May 09, 2013 01:03 pm Post Subject:

You need to take a close look at both the group contracts. Are they group contracts though? Look at the benefit provisions in that case.

Posted: Wed May 22, 2013 03:28 pm Post Subject:

Are they group contracts though?

Gee, Patricia, if you had read this first:

I am insured under my group plan and also have secondary insurance under my husband. Both plans are HDHP

what would you say?

This is one of the reasons when having more than one HDHP that covers a husband and wife (or an entire family) is unnecessary -- other than the fact that it provides the ability to fund an individual HSA for the long term, which could have a different benefit in the future.

Each HDHP is a separate plan, and each will be primary for the one who is covered as an employee. The only way the "secondary" company would become involved is if some medical expense were excluded from coverage under the primary plan. But that would be subject to a second deductible.

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