dual insurance coverage too

[fastblade]

What is the name of your state (only U.S. law)? IL

I did notice that there are several threads regarding dual insurance coverage and I read through them but still not clear on if it will be beneficial for my daughter being covered under both my husband’s and my employer plan. I am trying to do the math and hope that the expert on the forum can help me out.

Here is the situation:

My daughter is receiving ongoing therapy and expects to do so in the coming years. We have been hitting out of pocket maximum every year. Both my husband and I have group insurance through employers. By birthday rule under both plans, his insurance will be the primary if we were to cover her under both plan.

My husband’s plan has deductible/max out of pocket of $500/$2000, 20% co-pay while mine has $800/5500, 10% co-pay. My husband’s plan also has 60 therapy sessions cap per calendar year.

So here comes the question:

Assume that she has 100 therapy sessions a year at a cost of $10,000 ($100/session).

I would think the first five sessions of $500 will go to both primary and secondary deductible and max out of pocket.

The next three sessions Primary would pay $240, while secondary would pay nothing. Will the entire $300 be applied to secondary deductible or only the $60 I paid applies? How much is contributed to out of pocket max for each plan?

Assume that the first eight sessions satisfy the deductibles for both plans, for the sessions after first eight, the primary will pick up $80 per session and the secondary will pick up $20, how much will be contributed to out of pocket max for each plan?

After the sixty sessions, the primary will not pay any amount as it was capped. Then I would assume that the secondary will pay $90 for remaining sessions?


Also, how does the coverage work when a service is covered by secondary, but not primary?


I know there is a lot of math going on. Thanks for your help!

[ecmst12]

You need to call the secondary plan and ask them these questions. The answers will be specific to the plan and are not universal.