When an individual is covered by two medical insurance policies, the coordination of benefits (COB) rules come into play to determine how the benefits are paid out.

Typically, the primary insurance plan, which is the one held by the policyholder as the main source of coverage, will be responsible for paying the majority of the expenses according to its policy terms. The secondary insurance plan then comes into play to cover some or all of the remaining costs, depending on its coordination of benefits rules. This process ensures that the individual does not receive more than 100% coverage for a claim, as the two plans coordinate to complement each other rather than duplicate coverage.

FAQ

1. Can I have two medical insurance policies at the same time?
Yes, it is possible to have two medical insurance policies concurrently. This is known as "dual coverage."

2. Does having two medical insurance policies mean I receive double the benefits?
Having dual coverage does not necessarily mean you receive double the benefits. Instead, the two policies work together to coordinate benefits and may cover costs that the primary policy does not cover.

3. How does coordination of benefits work with two medical insurance policies?
When you have two medical insurance policies, one policy becomes the primary insurer and the other becomes the secondary insurer. The primary insurer pays the primary portion of the claim, and the secondary insurer may cover some or all of the remaining costs, depending on the specifics of each policy.

4. Will having two medical insurance policies increase the likelihood of claim approval?
Having two policies does not guarantee additional coverage since each policy has its own coverage limitations and exclusions. However, it may increase the overall coverage for certain medical expenses.

5. Can I choose which policy to use for specific medical services?
In most cases, you cannot freely choose which policy to use for specific medical services. The coordination of benefits rules and the "birthday rule" (which determines the primary insurer for dependents based on the parent with the earlier birthdate in the year) often dictate which policy pays first.

6. Are there any disadvantages to having two medical insurance policies?
One potential disadvantage is the added complexity in understanding how the two policies work together. It can also lead to increased paperwork and communication between the two insurance companies.

7. What should I consider before enrolling in a second medical insurance policy?
Before enrolling in a second policy, consider the additional cost of premiums, the specific coverage and limitations of the second policy, and how it coordinates with your existing coverage. It is essential to ensure that the added coverage justifies the extra expense.

8. How do I inform my healthcare providers about having two insurance policies?
Inform your healthcare providers about both of your insurance policies when seeking medical treatment. They can then submit claims to both insurance companies for coordination of benefits.

Remember, it's important to review the terms and conditions of both policies carefully and consult with a benefits specialist to understand how having two medical insurance policies will specifically impact your coverage and potential out-of-pocket expenses. At Apex Benefit Group, we assist individuals in navigating the complexities of dual coverage to maximize their benefits and minimize out-of-pocket expenses.