If I work two jobs, is there any benefit to me by accepting medical benefits from each of those jobs?
Total Comments: 3
Posted: Thu Sep 09, 2010 06:36 am Post Subject:
Certainly. Even though one of the two plans will be your primary coverage (probably the one that covers you where you work the most hours), the two plans may not have identical benefits or coverage amounts. You can have up to 100% of your medical expense paid between the two policies, but you cannot receive a benefit in excess of 100% of a covered loss.
You would need to determine which policy is your PRIMARY coverage, and file you claims with that company first. Unpaid amounts might be covered in full by the second policy.
Posted: Thu Sep 09, 2010 10:34 am Post Subject:
Hi Max, I do understand that the unpaid amount could be compensated by the other policy. But would it be under the OP's rights to choose the primary policy? Don't we have any state laws guiding us regarding such decisions?
Posted: Thu Sep 09, 2010 03:37 pm Post Subject:
But would it be under the OP's rights to choose the primary policy? Don't we have any state laws guiding us regarding such decisions?
Absolutely! There are state laws that TAKE AWAY THE ABILITY OF THE INSURED to choose which policy is primary for exactly that reason. To prevent the insured from deliberately picking the policy with the better benefit.
Sounds harsh, but it's called "Coordination of Benefits", and COB language appears in almost every policy, because the laws usually state that any policy without a COB provision will automatically be primary when two or more policies apply to a single claim. No insurer wants to be forced to pay a claim like that.
When a person is covered by two policies as an EMPLOYEE (not as an employee and a dependent), the usual determination of "primary" is on the basis of which employment is primary -- and that would probably be the one where the most hours are worked. But some states would allow the policy that has covered the insured the longest to be primary (the theory is that they have been paid more premium over time, and should return more of it in the form of a claims payment).
When a person is covered by more than one policy as an employee and a dependent (not the OP's situation -- "If I work two jobs . . ."), then the policy that covers them as the employee is their primary coverage, even if the other policy would provide a better benefit.
The COB provision as it applies to children is even more confusing. Children covered under more than one policy as dependents cannot begin to invoke the EMPLOYEE determination of primacy. Instead, depending on the state law, children will either find their father's policy to be their primary coverage (GENDER rule) or the policy of the parent whose birthday is earliest on the calendar (BIRTHDAY rule).
California is a BIRTHDAY rule state. If mom's birthday is in January, and dad's is in February, even though dad's policy costs less and provides more benefits, mom's policy is primary for the kids.
It is all governed under state law. The decision is out of the hands of BOTH the insurance company and the insured.
Posted: Thu Sep 09, 2010 06:36 am Post Subject:
Certainly. Even though one of the two plans will be your primary coverage (probably the one that covers you where you work the most hours), the two plans may not have identical benefits or coverage amounts. You can have up to 100% of your medical expense paid between the two policies, but you cannot receive a benefit in excess of 100% of a covered loss.
You would need to determine which policy is your PRIMARY coverage, and file you claims with that company first. Unpaid amounts might be covered in full by the second policy.
Posted: Thu Sep 09, 2010 10:34 am Post Subject:
Hi Max, I do understand that the unpaid amount could be compensated by the other policy. But would it be under the OP's rights to choose the primary policy? Don't we have any state laws guiding us regarding such decisions?
Posted: Thu Sep 09, 2010 03:37 pm Post Subject:
But would it be under the OP's rights to choose the primary policy? Don't we have any state laws guiding us regarding such decisions?
Absolutely! There are state laws that TAKE AWAY THE ABILITY OF THE INSURED to choose which policy is primary for exactly that reason. To prevent the insured from deliberately picking the policy with the better benefit.
Sounds harsh, but it's called "Coordination of Benefits", and COB language appears in almost every policy, because the laws usually state that any policy without a COB provision will automatically be primary when two or more policies apply to a single claim. No insurer wants to be forced to pay a claim like that.
When a person is covered by two policies as an EMPLOYEE (not as an employee and a dependent), the usual determination of "primary" is on the basis of which employment is primary -- and that would probably be the one where the most hours are worked. But some states would allow the policy that has covered the insured the longest to be primary (the theory is that they have been paid more premium over time, and should return more of it in the form of a claims payment).
When a person is covered by more than one policy as an employee and a dependent (not the OP's situation -- "If I work two jobs . . ."), then the policy that covers them as the employee is their primary coverage, even if the other policy would provide a better benefit.
The COB provision as it applies to children is even more confusing. Children covered under more than one policy as dependents cannot begin to invoke the EMPLOYEE determination of primacy. Instead, depending on the state law, children will either find their father's policy to be their primary coverage (GENDER rule) or the policy of the parent whose birthday is earliest on the calendar (BIRTHDAY rule).
California is a BIRTHDAY rule state. If mom's birthday is in January, and dad's is in February, even though dad's policy costs less and provides more benefits, mom's policy is primary for the kids.
It is all governed under state law. The decision is out of the hands of BOTH the insurance company and the insured.
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