Medical insurance question, if you can help...

[TravelingGal]

OK, I am hopelessly bad when it comes to HR related stuff. Wondering if you can put in your two cents.

There are three of us in our family. I have my own HMO insurance through work and TGuy has Amelia and himself under his work which is a PPO.

We both have open enrollment this month. Would it be a waste if we added all of us to each of our respective employers plans? It would be about $160 extra a month we would be paying for this....

I ask because if one of us loses our job, we both still have insurance for the entire family. Cobra is really expensive ($400 per person a month, I think). Do you think this makes sense?

 

[TravelingGal]

btw, the reason I ask is I vaguely remember hearing once it doesn''t make sense to do this, and I can''t for the life of me remember what the reason was...do other PSers double up on health insurance?

 

[Tacori E-ring]

TGal, I would call and see if one of you lost your jobs if the other''s plan would let you add the other family member(s). We pay for blue cross and we have a special enrollment once a year BUT there are special circumstances (like marriage, birth of a child, adoption) where you can add a person anytime. It is called a lifestyle change. Just an idea to save money!

 

[TravelingGal]

Date: 9/29/2008 1:45:03 PM
Author: Tacori E-ring
TGal, I would call and see if one of you lost your jobs if the other''s plan would let you add the other family member(s). We pay for blue cross and we have a special enrollment once a year BUT there are special circumstances (like marriage, birth of a child, adoption) where you can add a person anytime. It is called a lifestyle change. Just an idea to save money!

Thanks Tacori. I believe the answer on mine was no...marriage, child is OK, but not the loss of a job where you have to add the others on. Still, it''s open enrollment, so it''s a good idea to have us both call! Thanks!

 

[littlelysser]

Tgal - I'm confused. So you are talking about being insured through both of your employers? I'm not sure you are even allowed to do that...I'm not sure.

But regardless of that, I think it is unnecessary.

It is my understanding that if you both maintain your separate insurance, and say you lost your job, you should be able to be added on to Tguy's policy pretty much immediately (or him and Amelia to yours, if he'd lose his job).

When my judge retired last December, I lost my health insurance on the day he retired. However, we were able to immediately add me to DH's insurance, as loss of a job is a life-changing even that allows you to make additions, subtractions to your policy, regardless of whether it is an open period or not.

I'm sure there are provisions in both of your policies which set forth what constitutes a life-changing event. I'd definitely look into that before I'd spend $160 a month on something I *think* may be unnecessary.

ETA - I'm not sure why it is a bad idea, but I have the same vague recollection that it is...

 

[CDNinNYC]

Date: 9/29/2008 1:45:03 PM
Author: Tacori E-ring
TGal, I would call and see if one of you lost your jobs if the other''s plan would let you add the other family member(s). We pay for blue cross and we have a special enrollment once a year BUT there are special circumstances (like marriage, birth of a child, adoption) where you can add a person anytime. It is called a lifestyle change. Just an idea to save money!

I Agree with Tacori. I worked in HR before moving to the US and all the insurance companies I dealt with allowed a special enrollment for a ''change in circumstance'' such as job loss, divorce, marriage, new baby, etc... I would confirm with your HR Rep that this option is available to you.

Also, if it is available, please make yourself aware if there is a timeframe in which you need to make the change. In my past experience it''s always been you have 30 days from the ''event'' to make any changes to your benefits.

HR may also ask for ''proof'' of your ''change in circumstance''.

 

[elle_chris]

The only problems it would cause is which policy is primary for your daughter.

I "think" the birthday rule may still apply, as in "whose ever birthday falls earlier in the year is the primary insurance for the dependant".
So if your daughter is covered under your husbands plan, but your birthday is earlier, she would now be covered under your plan. That''s something to consider if you want her under a PPO and not an HMO.

The other is obviously cost. Like Tacori said, companies allow enrollment during the year for lifestyle changes. I''d ask your HR department before making any changes.

The third reason is if you show both insurances, you''re asking for nothing but trouble. The plans fight amongst themselves as to who''s primary, and it can take months to be resolved. This happened to my dad when he had surgery. Three Insurance Co.''s and none of them wanted to pay. Each pointed their finger at the next.

So if you do opt to have two plans, don''t show both to the doctor as neither would be a secondary or supplemental type of insurance. Always stick with one plan and keep the second as a backup if the Dr/Hospital/Clinic etc. don''t accept your first choice.

 

[CDNinNYC]

Date: 9/29/2008 1:53:09 PM
Author: littlelysser
Tgal - I'm confused. So you are talking about being insured through both of your employers? I'm not sure you are even allowed to do that...I'm not sure.

But regardless of that, I think it is unnecessary.

It is my understanding that if you both maintain your separate insurance, and say you lost your job, you should be able to be added on to Tguy's policy pretty much immediately (or him and Amelia to yours, if he'd lose his job).

When my judge retired last December, I lost my health insurance on the day he retired. However, we were able to immediately add me to DH's insurance, as loss of a job is a life-changing even that allows you to make additions, subtractions to your policy, regardless of whether it is an open period or not.

I'm sure there are provisions in both of your policies which set forth what constitutes a life-changing event. I'd definitely look into that before I'd spend $160 a month on something I *think* may be unnecessary.

I can't speak for regulations in California but in Ontario you are allowed to have coverage under both spouse's plans. The benefit in having this is that anything not covered by the first plan is put on the second one.

For example, say your benefits only cover 80% of the cost. The 20% not covered can then be put on your spouse's insurance.

ETA: the birthday rule should still apply. If your birthday comes up first in the calendar year, your family's medical/dental costs will go through your insurance first. The balance, if any, would then go through your spouse's insurance.

 

[Tacori E-ring]

Yes, I meant to mention you only have 30 days after the change and I am sure they do ask for some sort of proof.

 

[elle_chris]

Date: 9/29/2008 2:04:19 PM
Author: CDNinNYC

Date: 9/29/2008 1:53:09 PM
Author: littlelysser
Tgal - I''m confused. So you are talking about being insured through both of your employers? I''m not sure you are even allowed to do that...I''m not sure.

But regardless of that, I think it is unnecessary.

It is my understanding that if you both maintain your separate insurance, and say you lost your job, you should be able to be added on to Tguy''s policy pretty much immediately (or him and Amelia to yours, if he''d lose his job).

When my judge retired last December, I lost my health insurance on the day he retired. However, we were able to immediately add me to DH''s insurance, as loss of a job is a life-changing even that allows you to make additions, subtractions to your policy, regardless of whether it is an open period or not.

I''m sure there are provisions in both of your policies which set forth what constitutes a life-changing event. I''d definitely look into that before I''d spend $160 a month on something I *think* may be unnecessary.

I can''t speak for regulations in California but in Ontario you are allowed to have coverage under both spouse''s plans. The benefit in having this is anything that is not covered by the first plan is put on the second one.

For example, say your benefits only cover 80% of the cost. The 20% not covered can then be put on your spouse''s insurance.

That type of plan is called a secondary or supplemental (e.g. AARP). These are both primary polices and unfortunately won''t usually cover the 20%. However, patients here are rarely billed for it as well.

 

[neatfreak]

Basically if you double dip with your insurance all you will be doing is allowing the insurance companies to fight about who will pay the claim if there is one. It's legal for you to have 2 insurances, but it could cause more headache than it's worth. As Elle said they are both primary polices, so you can't get one to cover the excess from the other or anything like that.

Most plans as Tacori mentioned do allow you to switch up your insurance for a "major life event" you just need to find out what that is on both the plans...I know for mine loss of a job/insurance certainly qualifies.

But $160 a month isn't insignificant, I think you'd be better just saving that for a rainy day. Even in the worst case scenario you can get Amelia covered through the state.

 

[~*Alexis*~]

I work in insurance...

First off, I would just have one person be the subscriber on the policy. It makes more financial sense and there is no point to keep both policies unless you have a large out of pocket max you need to meet or if you have a large deductible.

HMOvsPPO...well personally I would take the HMO. It gives you better options but the PPO you can see whomever you would like, but you pay more. Higher copays, ded''s and high out of pocket maximums.

If one of you would happen to lose your job your insurance would end at the end of the next month. They have to cover you for 30 after your policy expires, not the date you lose your job and they also have to give you a certficate of insurability (as long as they have no pre-existing Dx). At that time you would be able to apply under the other persons coverage because it is a change in life/circumstance. They have to allow you to do this, but that also only give you 30 days in order to add/drop a person.

It does not make sound financial sense. Worse comes to worse you could apply for MA in your state and you would be placed into a spend down but teh daughter would be covered because she is a minor.

hope that helps!!

 

[~*Alexis*~]

ETA:

If you do decide to have 2 insurances anyways...PLEASE make sure you designate who the primary and the seconary insurance is. If anyone covered went into a hospital and required a pre-cert of benefits and they did not make one primary and the other secondary it could cause you to have to pay OOP.

You also would want the primary payor to be the one with the most coverage. IE: 90/10 and the secondary policy would be the 80/20, if you did end up having an OOP then you would only owe the 10%, but keep in mind this does not include deductibles. So if your employer offers FSA or an HRA you might want to invest in one of those, plus you can use them for daycare, over the count meds and Rx''s.

 

[CDNinNYC]

Date: 9/29/2008 2:13:31 PM
Author: elle_chris
That type of plan is called a secondary or supplemental (e.g. AARP). These are both primary polices and unfortunately won''t usually cover the 20%. However, patients here are rarely billed for it as well.

Thanks for clarifying. We didn''t have to deal with primary and secondary plans. It''s interesting how similiar yet different insurance regulations/policies can be.

 

[elle_chris]

Date: 9/29/2008 2:29:38 PM
Author: ~*Alexis*~
I work in insurance...

First off, I would just have one person be the subscriber on the policy. It makes more financial sense and there is no point to keep both policies unless you have a large out of pocket max you need to meet or if you have a large deductible.

HMOvsPPO...well personally I would take the HMO. It gives you better options but the PPO you can see whomever you would like, but you pay more. Higher copays, ded's and high out of pocket maximums.

If one of you would happen to lose your job your insurance would end at the end of the next month. They have to cover you for 30 after your policy expires, not the date you lose your job and they also have to give you a certficate of insurability (as long as they have no pre-existing Dx). At that time you would be able to apply under the other persons coverage because it is a change in life/circumstance. They have to allow you to do this, but that also only give you 30 days in order to add/drop a person.

It does not make sound financial sense. Worse comes to worse you could apply for MA in your state and you would be placed into a spend down but teh daughter would be covered because she is a minor.

hope that helps!!

I also work in Insurance (but compliance now as opposed to billing etc), and it's interesting to me that you'd rather pick an HMO than a PPO.
I currently have a PPO through my husband, as my company only offers HMO's.
I found that with a PPO, while it's true that out of pocket costs are higher, I also have way more options than I did with my HMO. I also don't ever need to worry about someone in an office denying my claims or procedures due to lack of what they consiider medical necessity.
In other words, with a PPO, my doctor and I make my health decisions, not someone checking to see if the i's are dotted and the t's crossed.
I had Oxford for my HMO, and maybe it was just them, but I encountered nothing but problems from needing a referral to a specialist, to prescriptions not being covered because a cheaper alternative wasn't tried first.


edited to add: TGal, you need to weigh in the benefits from both plans and see what serves you guys best. Check what, and how much is covered. Check to see what you need referrals for, what drugs generic and name brand are covered. And most important, does your daughters doctor take your HMO if it winds up being your primary insurance.

 

[TravelingGal]

Oh my goodness...you guys are a huge help. Thank you all! I didn''t know about the birthday rule, but in my daughter''s case, that would be great since TGuy''s bday falls before mine and we prefer his insurance for Amelia.

She''s really my only concern. I like my HMO. But we had to get PPO for TGuy because we wanted it for Amelia (her ped does not take HMO and he was worth the extra PPO expense).

I will call my policy this week and ask about the lifestyle change...thanks so much!!!

 

[~*Alexis*~]

Date: 9/29/2008 2:46:16 PM
Author: elle_chris

Date: 9/29/2008 2:29:38 PM
Author: ~*Alexis*~
I work in insurance...

First off, I would just have one person be the subscriber on the policy. It makes more financial sense and there is no point to keep both policies unless you have a large out of pocket max you need to meet or if you have a large deductible.

HMOvsPPO...well personally I would take the HMO. It gives you better options but the PPO you can see whomever you would like, but you pay more. Higher copays, ded''s and high out of pocket maximums.

If one of you would happen to lose your job your insurance would end at the end of the next month. They have to cover you for 30 after your policy expires, not the date you lose your job and they also have to give you a certficate of insurability (as long as they have no pre-existing Dx). At that time you would be able to apply under the other persons coverage because it is a change in life/circumstance. They have to allow you to do this, but that also only give you 30 days in order to add/drop a person.

It does not make sound financial sense. Worse comes to worse you could apply for MA in your state and you would be placed into a spend down but teh daughter would be covered because she is a minor.

hope that helps!!

I also work in Insurance (but compliance now as opposed to billing etc), and it''s interesting to me that you''d rather pick an HMO than a PPO.
I currently have a PPO through my husband, as my company only offers HMO''s.
I found that with a PPO, while it''s true that out of pocket costs are higher, I also have way more options than I did with my HMO. I also don''t ever need to worry about someone in an office denying my claims or procedures due to lack of what they consiider medical necessity.
In other words, with a PPO, my doctor and I make my health decisions, not someone checking to see if the i''s are dotted and the t''s crossed.
I had Oxford for my HMO, and maybe it was just them, but I encountered nothing but problems from needing a referral to a specialist, to prescriptions not being covered because a cheaper alternative wasn''t tried first.


edited to add: TGal, you need to weigh in the benefits from both plans and see what serves you guys best. Check what, and how much is covered. Check to see what you need referrals for, what drugs generic and name brand are covered. And most important, does your daughters doctor take your HMO if it winds up being your primary insurance.

Yes, I was stating that for my personal needs. I very rarely am sick and I never have to go. So for someone who''s in my position then the HMO works better. If you have medical needs that are frequent (diabeties, hypoglycemia etc) then you might want a ppo...
It does totally depend on your situation.....

 

[Tuckins1]

Are you married? If so, you don''t have to worry about signing up for your spouses insurance during open enrollment... You can join during emergency times like if you or he loses a job, marriage, or birth of a child. (This is the norm, but you should check with your insurance provider to be sure.)

 

[arjunajane]

Sorry I don't have any advice for you Tgal - I just wanted to say, I work in insurance too but in Australia and this whole concept of two policies is so strange !
It is against the law here, would be considered fraudulent, and it would get you into trouble with your taxes.
However, I know your Ins. there is very different (and very confusing, if I may say so!)..
The main thing I would be concerned about is, as Neatfreak said, the two funds arguing about who is going to pay for you incase of a hospitalisation etc..

 

[TravelingGal]

Yes Tuckins, we are married. We are going to call this week to see what each of our respective insurance policies are.

Thanks Arjunajane, yes I agree it''s confusing. Perhaps a dumb question, but if you only submit one insurance card for whatever it is you are doing, doesn''t the hospital just bill that one?

 

[Allison D.]

Date: 9/30/2008 4:16:08 PM
Author: TravelingGal
Yes Tuckins, we are married. We are going to call this week to see what each of our respective insurance policies are.

Thanks Arjunajane, yes I agree it's confusing. Perhaps a dumb question, but if you only submit one insurance card for whatever it is you are doing, doesn't the hospital just bill that one?

I know it seems it should work that way, but it doesn't. Most healthcare forms ask you about supplemental coverages, so you have to list them.

Beyond that, a few things to help you, TGal.

1. Often, a family plan costs the same whether it's spouse or spouse/child, so you should have TGuy ask his company if there would be any additional cost if he were to add you to his insurance. My guess is no, and if that's true, you're potentially paying premiums to your own HMO that you wouldn't have to if you were all on the same policy.

2. It doesn't really make sense to duplicate coverage, though. It doesn't seem to make sense to pay $160 per month ($1,920 annually) for something you may never need, especially when that cost covers nearly 5 months of COBRA cost.

It would make sense if you weren't able to secure coverage at all, but it doesn't make sense economically as an alternate to COBRA.

 

[elle_chris]

I''m having a dull moment as I''m not understanding. But yes, they''ll only bill the insurance you show them. But like Allison said, they want to see if you have a secondary policy to cover the 20%. If you don''t, you just don''t show it. But don''t confuse that with what you have, as in two primary policies. You''re NOT required to show both as you don''t have a secondary.

 

[TravelingGal]

Thanks gals...I really appreciate you taking the time to answer such a dull question. I am really dumb when it comes to this stuff as I rarely every visit the doc (only when rearended while pregnant, pretty much) so I never pay much attention to my benefits, even though I know I should. I missed the window to call today so I will call tomorrow!

 

[TravelingGal]

Oh, and the reason I have kept my HMO is that I''ve heard (i.e., not researched for myself) that it''s cheaper to go the HMO route when having a kid.

 

[Linda W]

TG: DH and I always had each other insured on each others policies. His company paid for his, so it was nothing out of our pockets. Mine is a low monthly payment, so it doesn''t really matter.

When I had cancer, what his insurance didn''t pick up, mine did. Nothing came out of our pocket.

The same with both dental plans, what one didn''t pay, they other picked up. With the cost of dental procedures, I am glad to have it.


Linda

 

[neatfreak]

Date: 9/30/2008 6:06:42 PM
Author: TravelingGal
Oh, and the reason I have kept my HMO is that I''ve heard (i.e., not researched for myself) that it''s cheaper to go the HMO route when having a kid.

I would research that...there are MANY variations of HMO''s and PPO''s out there.