Benefits of having primary and secondary health coverage Author:    Posted under: Health InsuranceHealth Insurance questions answered

There are many reasons why any individual may have more than one insurance plan. You can acquire it through your spouse as a dependent on her plan while you yourself are covered as an employee where you work or you may have individual health insurance and kept it active after you enrolled in your employer’s plan. Yes, it does happen.

Back in the 1950s, duplicate coverage created problems for insurance companies, and it was because more and more families had both spouses in the workforce and were covered by their individual employers. The insurance companies realized that the insured person can actually make a profit from medical charges and insurance reimbursement having two premiums being paid for coverage. The insurance companies did not believe it was right to pay full benefits under both. However, the National Association of Insurance Commissioners worked with the insurance companies to resolve the problem in a manner they hoped would be fair to all, and as a result of this they formed what is known as the Coordination of Benefits Provision.

The coordination of benefits provision was simple: The Primary plan will pay its full benefits. And the other which is the Secondary plan will take care of what is remaining of the total medical bill, up to the maximum amount that it would have paid if it were the only insurance company involved. Through this, the insurer can have his or her medical bills paid virtually 100% by the collective efforts of the primary and secondary companies, but will not receive anything in excess.

“The provision says that the Primary Plan will pay its full benefits, and the Secondary Plan will pay the remainder of the entire bill. Clean, simple; the insurance company doesn’t pay double, and the insured person gets the claim paid at 100% of the total bill, leaving him/her to pay nothing out of pocket.”*

Clearly with a secondary coverage, you will have additional protection from medical emergencies and expenses. Through secondary plans, you can be reimbursed for additional medical expenses.

Another example is if your primary insurer pays a lower percent of the cost for the same service than the secondary insurer would pay, you can submit the remaining amount to the secondary health insurance plan. More over, if you exceed your lifetime maximum benefits for the year for your primary policy, you can turn to your secondary policy for additional benefits.

Remember though, that before you can buy a secondary plan, you must first have a primary policy that provides family coverage or plus-one.

One of the best ways to find a policy nowadays is to do comparison shopping and get quotes from several companies at the same time.

Be smart and make sure to check the certificate of coverage from the primary and secondary providers to see how they coordinate coverage before selecting the quote to buy.



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