Is there such a thing as too much health insurance?

September 27, 2005 9:18 AM

Redundant health insurance policies with the same insurance company: will they use this to screw me?

Currently, I'm covered under my husband's health insurance policy. He pays a small premium ($100/month pre-tax) for the both of us, which provides really excellent coverage through Anthem.

I just became eligible for health insurance through my own employer, who will pay 100% of my premium for a slightly different policy with Anthem. Since there's no cost to me, I'd like to enroll in my company's plan as well, because it offers a few benefits (like vision insurance) that my husband's plan doesn't offer. However, I would continue to use my husband's plan for doctor's visits, because of the lower co-payments, more robust coverage, etc.

My only concern is that, by having 2 policies with the same company, Anthem would try and hold me to whatever the lowest paid benefit is at any time. So if I need, say, X-rays, and my husband's plan would cost a $100 deductable, and my company plan would cost a $250 deductable, they would try to hold me to the higher deductable, even if I presented my husband's insurance card at time of service.

My husband and I discussed purchasing supplemental vision insurance through his plan, but the cost in premiums would be about equal to the cost we pay for exams, contacts, etc, so it's really of no benefit.

Unfortunately, I know first-hand that companies like Anthem will go to great lengths to avoid paying out benefits. Any advice or experience you've had with carrying multiple health insurance plans would be appreciated.

posted by junkbox to work & money (4 answers total)

Chances are, the policy in your own name will be considered your primary policy and, thus, coverage/benefits will be based on it.
Not sure if your husband's policy would be considerd for secondary coverage, especially since it is also an Anthem policy.
posted by Thorzdad at 9:26 AM on September 27, 2005

I expect they'd be required to pay based on the plan number that the health care provider gave them. If the provider gave them your husband's plan number, that's the plan they should use to figure disbursements. If the provider gave them your employer's plan number, then that's the one they should use.
posted by Kirth Gerson at 9:28 AM on September 27, 2005

This really is a question you should ask Anthem--policies and practices very quite widely--as do rules and regulations regarding coinsurance and subordination--call customer service (be persistent and stay on hold) and ask the specific questions you have--tell the rep you are taking notes, write doen the date, time, and persons name and then repeat your understanding of their answers--I have a hunch it will work out for you--Good luck and I hope you do not need your health insurance--PS do not rely on your HR departments understanding--no reflection on them but clear this up with the insurer--also--do not get your answers from your employer's Anthem rep as they may be a sales rep.
posted by rmhsinc at 9:44 AM on September 27, 2005

Your plan is primary, and your husband's plan is secondary. How it works is that your plan pays any claim as if no other coverage exists, and then the secondary plan pays as it would pay if no other coverage existed up to a maximum of 100% of the claim amount (i.e., coordinating the benefits can't ever mean making money off going to the doctor). Here's an example:

-Assume that both plans are exactly the same and have a $500 deductible and then cover benefits at 100%.
-You go to the hospital and incur $750 worth of charges.
-You submit the claim to Anthem and it will cover $250 (the claim amount less the $500 deductible).
-You can then submit the claim to Anthem again under your husband's plan and it will also cover $250 (the claim amt less the $500 deductible).
-Your total cost will be $250 and the deductible under both plans will be satisfied and future benefits will pay at 100%.

Anthem should have no problem having you in their system twice as you'll be in once under your own social or unique identifier and once as a dependent under your husband's social or identifier.

Do you have children? Coordination of benefits for the children is kind of awesome. The primary plan is determined using the birthdates of the parents. The plan of the person whose birthdate is earlier in the year is primary, and the other person's secondary. If you have the same birthdate, the plan that has been in force longer will be primary.

If you get the health insurance for free from your employer, it almost always makes sense to take it, which is why almost all employers require an employee contribution or provide some kind of salary gross-up for people choosing to waive coverage because of coverage under a spouse's plan.

Vision plans tend to be a waste of money. Your health insurance will probably cover a vision exam (you can check this out in the plan booklet you should be getting) at least once every 24 months, although there's no guarantee on this. Most eye glass/contact places (I'm blanking on what they call these) will give you a small discount (10-20%) just for asking. Say you have medical insurance through Anthem and see what happens. Vision plans that cover frames and lenses and contacts tend to cost more per month than you're going to use them for and unless your employer contributes, it's probably not worth it.
posted by MarkAnd at 11:04 AM on September 27, 2005