Double health insurance w/ 2nd policy having different coverages.?

Question

I was wondering how having two health insurance policies works in the following (very specific) case. Read below about details:

1) Child has Autism.

2) Father's current insurance plan may not cover behavioral therapy for autism, which is very expensive.

3) State of residence (Indiana) has a mandate that employer-based insurance policies cover behavioral therapy for Autism.

4) Father's employer is not subject to mandate because its headquarters is out-of-state.

We are considering getting the Mother a job, with insurance, that is in-state and subject to the mandate specifically so this therapy is covered. Individual insurance will not work because this is a preexisting conditition, so group insurance is required.

However, the second policy would result in us being double insured. The father cannot waive his insurance until the next open enrollment period in January.

How does double insurance work in this case?

Answer 1

One insurance would be the primary and the other would be the secondary.....

If you are getting the mother to work to cover this particular condition, I would not even MENTION that your child has another insurance policy when it regards getting treated for this particular issue....

Since your wife is going to work for this, it might be a good idea to research each of the plans to see which insurance is better.....I do believe that Father should check with an attorney (free consultation) since I would be curious if fathers employer was in violation of the law (headquarters out of state is no excuse....when doing business in Indiana, Indiana's rules and regulations should apply)

Answer 2

I agree with the other posters about the state mandate. They are obligated to follow state laws if they operate a business in that state. You should have this point clarified by your state's insurance department and get something in writing from your employer's insurance.

The birthday rule generally applies for children. Whichever parent's birthday comes first in the calandar year is primary for the child. ( The parent's birth year is not important).

Example:Father's birthday is 2/19

Mother's birthday is 5/21

Father would be primary, mother would be secondary. If father's insurance denies, then that EOB is forwarded to the secondary and the secondary considers the claim for payment. If primary pays something on the claim, secondary will usually only pick up the balance to the maximum amount they would have paid as primary.

Answer 3

Pre-existing conditions only come into play when you have had a lapse in coverage.  If the child was continually covered under the father then it wouldnt apply.  The insurance just wants to be sure that you are hoarding illnesses and then getting them all cured the day you get insurance.  If you show continued coverage then they assume you are being treated right along.

I process secondary claims for BCBS.  If the primary payor (insurance) doesnt cover something as long as its a benefit under the 2nd plan then the 2nd plan will pay as primary.  You're DR will just need to submit a copy of the denied explination of benefits (EOB) from the primary when they file their secondary claims.

I WOULD NOT ADVISE that you keep his condition a secret, especially if his coverage never lapsed.  We also process coordination-of-benefits-recovery here and you don't want a $40,000 refund letter because the insurance finds out down the road you did have another carrier and they paid out of order(they have ways of finding out/cob cross-overs etc).  At that point it gets sticky because plans only allow you to file claims for a certain amount of time and once the 2ndary gets their money back its usually too late to refile to the right payor (to get the proper denial anyway).

I hope this helps and best of luck..

Answer 4

I would disagree with point #4.  If there are operations in your state, the company has to comply with the requirements of that state.  I would file a complaint to your state insurance department (because your HEALTH INSURANCE policy is issued in that state!  Because insurance is regulated on a state by state basis!!).

Mom's policy is primary for mom.  Dad's policy is primary for dad.  The two insurance companies fight it out, over who is primary for the kids.  But I don't think it's going to come to that - see paragraph #1.

Answer 5

no