Can You Have More Than One Health Insurance

What Is The Contribution Clause In Health Insurance

To make it easier for policyholders to take advantage of multiple health insurance plans, the Insurance Regulatory and Development Authority of India has made changes to the rules and regulations. Prior to 2013, the IRDAI made it mandatory that the total medical expenses had to be shared by the insurance companies in proportion to the sum assured by them. This is known as Contribution Clause in health insurance. However, this has been eradicated and now the policyholder can approach any one of the insurers to settle the claim. But how to claim from two or more insurance companies? Read on to find out.

Got Multiple Health Insurance Policies Heres How To Make Claims From Multiple Health Insurance Policies

• Date : 04/10/2022

Mediclaim process in case of multiple health policies

There could be scenarios where you may have two or more active health insurance policies covering your medical bills. The most common such scenario is an existing personal health cover in addition to an employer-provided health insurance plan. Then there is the option of buying more than one health policy from the same insurer, for added benefits. The IRDAI allows a policyholder to claim for a medical event from more than one policy. Taking this into consideration, you may deem it appropriate to buy an additional health policy to expand your sum assured even further.

However, you cannot claim the same hospital bill from two policies simultaneously. Here are a few things to keep in mind if you plan to raise multiple health insurance claims against the same medical expense.

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What Is The Difference Between Primary And Secondary Health Insurance

When a member has double insurance, his or her individual circumstances determine which insurance is primary and which is secondary. Following are some examples of how this might work:

• A married couple A wife has a health plan with her employer, but her husbands health plan also covers her. In this case, the wifes employer is the primary insurer and the spouses health plan is secondary.
• A child under 26 The Affordable Care Act lets children stay on their parents health plan until they turn 26. That could result in a child having her own health plan through an employer while remaining on the familys plan. In that case, the childs health plan is primary and the parents plan is secondary.
• Parents have separate plans and a child is on both plans In this situation, the so-called birthday rule applies. Whichever parent has the earlier birthday in a year is considered the primary health plan and the other spouse is secondary. Its not which parent is older. Instead, its which one has the earliest birthday in a calendar year.
• Medicare and a private health plan Typically, Medicare is considered primary if the worker is 65 or older and his or her employer has less than 20 employees. A private insurer is primary if the employer has 20 or more employees.

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Does Secondary Insurance Cover The Primary Deductible

Typically not. If you have a deductible on one or both plans, you will need to pay those deductibles before your insurance reimburses you for care.

Depending on the type of plan you have, there is not necessarily a pass-through or a honoring of a deductible from one plan design to the next, Mordo says.

Chris Kissell is a Denver-based writer and editor with work featured on U.S. News & World Report, MSN Money, Fox Business, Forbes, Yahoo Finance, Money Talks News and more.

How To Determine Which Insurance Is Primary And Which Is Secondary

When considering primary and secondary insurance, there are certain rules about who pays first depending on the situation. For example, if youre a dependent with two parents who both cover you under their health insurance plans, your primary insurance is decided by the birthday rule. This means that the primary coverage comes from the parent whose birthday comes first in the calendar year. When you file a claim, your primary insurance will provide you with your benefits regardless of your secondary plan. Then your secondary plan kicks in and covers some or all of the remaining cost. The following chart goes over a few common scenarios determining primary versus secondary coverage.

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How Having Multiple Health Insurance Policies Works

Having multiple health insurance policies doesnt mean you get reimbursed twice for a doctors visit or two bottles of medication. If you have more than one plan, the total amount that your plans pay will never exceed 100% of the cost. Its important here to understand the difference between primary versus secondary insurance.

If you have more than one health plan, coordination of benefits is the process that decides which insurance pays first for a claim. Heres where primary versus secondary insurance comes in:

• Primary insurance: the insurance that pays first is your primary insurance, and this plan will pay up to coverage limits. You may owe cost sharing.
• Secondary insurance: once your primary insurance has paid its share, the remaining bill goes to your secondary insurance, if you have more than one health plan. Your secondary insurance may cover part or all of the remaining cost.

Note that both the primary and secondary insurance will cover up to plan limits. After the secondary insurance has paid its share, you may be responsible for any remaining amount that wasnt covered. So, even if you have multiple health insurance policies, you may still have leftover out-of-pocket medical costs.

If youre concerned about your out-of-pocket costs, taking the time to shop and compare health plans may help. eHealths plan finder tool makes it easy to compare plan costs like premiums, deductibles, and copayments side by side.

Can A Person Get More Than One Health Insurance Policy

A policyholder can have multiple health insurance policies. However, you cannot claim the same expenses from multiple insurers.

An individual can use various health insurance policies for a single claim, such as an employer’s group policy, a health policy, and top-up health insurance. A person can have multiple health insurance policies and can claim them from two different companies or different service providers. It is not limited to one.

Multiple health insurance policyholders have the choice to claim between several health insurance plans. If one policy claim is higher than the other one, the individual can opt between these two to get the best advantages.

Apart from this, when an individual buys multiple insurance plans, it lowers the premium costs. In addition, a person can also obtain maximum coverage during illnesses from several health insurance plans.

A common approach for a person to have two India insurance policies is obtaining the claims settlement summary. After that, one must obtain copies of the bills. An individual can now approach the second insurance company and ask for the remaining sum. The remaining sum is only paid after this whole process.

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Should I Have More Than One Health Insurance Policy

It is not an unusual situation for a person to have coverage under more than one health insurance policy. For example, this often happens with spouses who have their own health insurance through their employers and are also covered through their spouses employers. Employees age 65 and older may have Medicare in addition to employer-sponsored health insurance. Retirees may have employer-sponsored retiree insurance, plus Medicare coverage.

Insurance companies will never pay more than 100% of the cost of your medical care. Nevertheless, you may save money by having more than one health insurance plan.

How Are Benefits Coordinated When You Have More Than One Health Insurance Policy?

When you are covered under more than one health plan, certain rules apply as to which plan pays for what. These coordination of benefits rules can vary somewhat among different states and providers, but the general idea is that one plan is primary and the other is secondary. When a claim is filed, the primary plan will pay what it is responsible for paying, as though the other plan did not exist. The secondary plan will then pay what it covers of whatever is left of the bill, up to 100%.

Which Health Insurance Plan Is Primary?

What Happens If You Are Covered Under Medicare?

Coordination Of Medical & Dental Benefits

I Just Had A Baby Is She Covered Under My Insurance Policy

Yes, from the moment of birth or in the case of an adopted child from the moment the placement papers are signed for 31 days. The insurance company may require you to notify them and/or pay an additional premium within that 31 days to continue coverage beyond that point. Title 24-A M.R.S.A. §2743, §2834 and §4234-C.

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If You Lose Your Group Health Benefits

If you lose your job or your hours are cut, you may also lose your group health benefits.

• You may be able to buy continuation health coverage.
• Or you may be able to buy an individual policy .
• Or you may qualify for a public program .
• Or you may be able to get on your spouse or partners group insurance. Try to do this as soon as possible, to avoid a gap in coverage.

You can keep your employers health coverage

You and your dependents may be able to keep your existing health coverage even if you lose your group health benefits. These options are called continuation coverage.

If you lose your coverage, your employer must provide you with information on your options for continuing your existing coverage. You may see options with names like COBRA, Cal-COBRA, Conversion or HIPPA. If you choose one of these options:

• You have to pay all of the premium.
• After you use up one kind of continuation coverage, you may be eligible for another kind of coverage.
• There are deadlines and other requirements for each kind of continuation coverage.

If you have any questions about your options, contact the Consumer Hotline at the Department of Insurance 927-4357 for assistance.

Continuation Coverage or an Individual Policy?

Buying Individual Health Insurance on Your Own

People usually buy individual health insurance because they do not have group insurance through a job and they do not qualify for any public program.

Medi-Cal

How Does It Work With Multiple Health Insurance Plans

You dont get double benefits if you have two health insurance plans. The total combined amount your plans pay out will never exceed 100% of the cost of your care. A process called coordination of benefits determines which of your plans pays first for a particular claim. One health insurance plan is considered primary, and the other is secondary.

• Primary insurance pays first, up to policy limits. You may have a copay or cost-sharing. The primary health plan is required to pay everything it would pay, regardless of any secondary plan.
• Secondary insurance applies to the remaining balance after your primary insurance has paid its portion. This plan may cover all or a portion of the remaining costs. Secondary plans may take the health insurance benefits provided by the primary plan into consideration, after which remaining allowable costs are considered for payment.

Both primary and secondary health insurance will only cover up to plan limits. Even after both plans have paid, you may have out-of-pocket expenses remaining.

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Why Would You Need Two Health Insurance Plans

With dual health insurance plans, one is considered primary while the other is secondary. Having dual health insurance plans can sometimes reduce your out-of-pocket costs, but other times the additional deductible and premium payment can increase your costs overall.

Dual health insurance plans are a common option for seniors to help reduce the cost of medical expenses beyond what Original Medicare provides. Adults may add a secondary health plan for dental care that their primary insurance doesnt cover. Parents may decide to add additional coverage and accidental injury protection for their sports-loving teenagers in the case of injury. Anyone can benefit from two health plans, especially if you receive coverage through your employer, spouse, or parents plan. If you or your spouse needs a long-term care facility, it makes sense financially to have a secondary health plan that can shoulder the extra expenses.

There are various reasons people may want two health insurance plans, such as:

There are three main scenarios for having dual health plans.

How Is Group Health Insurance Different From Individual Health Insurance

A health insurance plan that covers multiple people, such as one provided to employees by an employer is called group coverage. However, a health insurance you buy on your own is called individual coverage.

A health insurance plan that covers multiple people, such as one provided to employees by an employer is called group coverage. However, a health insurance you buy on your own is called individual coverage.

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How Do I Coordinate Benefits

Youll want both of your health insurance plans to pay and for you to pay as little as possible, maybe even nothing at all. The way coordination of benefits works is that when you have a health insurance claim, it should go first to the primary plan. That insurer will pay what it owes. If theres a remainder, then that bill goes to the second insurer, which pays what it owes. Youll then be responsible for whats left over, if anything.

So, lets say you have a bill for $500 from a visit. If your primary insurer pays $300 and your secondary insurer pays $150, you will owe $50.

When you visit the doctor and register as a new patient, youll most likely be given a form to fill out about your insurer. Here, youre responsible to give the accurate information about both health plans so that the medical billings department can bill your insurers accurately.

If you only had one insurance plan when you began seeing a specific doctor and now have two plans, its important for you to share this information with the billings department. Otherwise, they will bill you according to the initial information you gave them.

Drawbacks Of Having Two Health Insurance Plans

Even though there are a lot of benefits that come with having two health insurance plans, there are a handful of drawbacks as well. Some of the biggest drawbacks of having two health insurance plans include:

• Having two health insurance plans, it doesnt necessarily mean that you will be completely covered regarding your out-of-pocket expenses. Remember that the combined coverage of your plans cannot exceed 100 percent of your out-of-pocket costs. If you want to get paid for going to the doctor, that will not happen even if you have multiple policies.
• If you have two health insurance plans, you will still be responsible for two premiums and two deductibles. That means that you could end up incurring additional expenses.
• If you have two health insurance policies, you will need to navigate to separate policies and rules. Furthermore, the reimbursement process may take longer or have more mistakes because your health insurance providers have to navigate multiple benefits.
• With two health insurance policies, they might be too similar and could overlap with their coverage, meaning that you do not get a lot of additional benefits.
• When you go to the doctors office, the doctor may only want to bill a single policy. They may not want to bill the other policy. This means that the process could become more complicated, and your doctor might get frustrated.

Even with two health insurances, the coverage will not exceed 100% of your health costs

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Benefits Of Having More Than One Health Policy

1. You Can Purchase Different Health Insurance Policies Across Multiple Companies

If there is an insufficient claim amount in a single policy then you can choose to purchase a different health policy that offers you a greater claim amount from any other health insurance company. If your second policy has a larger claim amount than the sum insured in the first policy then you have the option of claiming the same on the second policy. However, there are certain regulations that you need to follow while making such claims. Whenever you are buying two separate health policies, you must inform the insurers about the same, otherwise, your claim amount can be reduced or rejected for non-disclosure of information.

2. You Can Choose A Policy That Does Not Have Any Deductibles

When you are buying two different health insurances be aware of their respective claim amounts, sum insured and the deductible amount. You should choose a policy that comes without a deductible amount as a part of the claim then becomes payable by the policyholder themselves or reimbursed through another policy.

3. You Can Avail A Cashless Claim Benefit

Therefore having more than one health insurance policy results in maximized benefits and covers you not only against medical emergencies but also solves the problem of getting a reimbursement as well. However, you must bear in mind that no matter how many insurances you might choose to invest in, the claim or coverage amount cannot exceed 100%of the total cost.