Secondary Health Insurance better, what to do?

November 11, 2008 12:23 PM

How do primary and secondary health insurance policies work together? Will I get the advantages of the secondary even though I have the primary?

I have a PPO plan from Blue Cross Blue Shield (BCBS) of Texas through my employer. My husband's employer has not provided health insurance in the past, but is offering a plan through BCBS of Massachusetts starting with the new year. The coverage under his plan is better with no deductible, $5 cheaper copays and substantially better hospital coverage. The cost to him to add just our son is the same as to add me and our son, so we are planning on enrolling both of us.

My question is, will I get the advantages of his plan over mine, or since the Texas plan is my primary, will I just get those terms? I'm thinking what should happen is I should get any feature of the secondary plan that is better than my primary.

Will this happen automatically? Or will I need to submit paperwork? Like to get the $5 back on office copays?

I don't think I can get out of my primary because it is paid for 100% by my employer and so I don't think I can waive it.

posted by ewiley28 to work & money (3 comments total)

You can certainly waive any plan, you will just have to bring proof of other insurance. This is not difficult to obtain.
posted by micawber at 12:58 PM on November 11, 2008

I just went to a (really boring) seminar that covered this. In California, at least -- and I think it's true anywhere -- you must first bill the primary insurer. Any costs that aren't covered can then be billed to the secondary insurer.

If your child is enrolled in both plans, they use the "birthday" rule to determine which plan is the child's primary insurer. The parent who was born earlier in the year holds the primary plan. So if you were born in January and your husband was born in December, the kid is covered by your plan first. From then on, it's the same -- bill the primary insurer first, and then you can bill the secondary insurer for any costs not covered.

If one plan is substantially better than the other, it might be to your benefit to enroll the child only in that plan.

And yes, you ought to be able to opt out of the coverage provided by your employer. Contact your HR administrator.
posted by mudpuppie at 1:40 PM on November 11, 2008

here is my experience, tho it is only with dental.

first, the provider will bill your primary insurance (which for you will be your employer's, and for your husband, his employer). after they get all they're due from the primary, they will bill your secondary for the remaining amount.

so, if after billing primary, there was a $50 balance, they would bill secondary for that. if secondary pays 80%, then secondary would pay 80% of that $50, leaving you with a balance of $10 to pay.

for us, with dental issues, it's freaking awesome to have two insurances. depending on how much your premium and deductible is, it may or may not be awesome for you to have two insurances. you should be able to opt out of your coverage if you are getting on your husband's.
posted by misanthropicsarah at 9:09 AM on November 12, 2008