Pregnant, PPO primary and HMO secondary

[Ssmith88]

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

I am pregnant due March 14th. I receive health insurance through my job at no cost to me. It's a BCBS PPO policy. In December my husband can add me to his BCBS HMO policy at no cost to him. My doctor and hospital are in network for both and accept both policies. My question is, can I use both? My PPO is an 80/20 plan with an $500 deductible and $2,500 out of pocket. The HMO has $0 deductible and $1,500/per person out of pocket. I was told that I can keep my PPO unt August when I quit and just use the HMO. But thag doesn't sound right. How will the coordination of benefits work? Should I cancel my PPO coverage and just use the HMO? My child will go on my husbands because his birthday is before mine and I will lose mine anyway in August. Thank you

 

[cbg]

You can, in that there is no law that says you cannot be covered on both polices. However, it may not be cost effective to do so.

The only ones who can tell you for certain how the coordination of benefits WILL work is the insurance carriers themselves. I can tell you how it USUALLY works, but as health insurance and health insurance laws change, there is no guarantee that what I tell you is going to be the case for you. The law does not dictate how the two plans coordinate - that is a matter of the individual policies.

In MOST cases, the primary policy pays first according to its contract. Then the secondary policy reviews the claim as if it were primary. If the primary policy has paid the same amount, or more, than the secondary policy would have paid if it were primary, then the secondary policy will pay nothing. If the secondary policy would have paid more if they were primary, they will pay the difference between what has already been paid, and what they would have paid. They do NOT necessarily pick up everything that the primary policy left unpaid.

An illustration; say there is a bill for $100 and the primary policy pays $80. If the secondary policy would have paid $80 or less as the primary policy, they will pay nothing. If the secondary policy would have paid $90 as the primary policy, they will pay $10. ONLY if they would have paid the full $100 if they were primary, will they pay the entire balance.

YMMV. Once again, insurance laws and insurance plan designs are changing rapidly. USUALLY it is not cost effective to have two plans unless the secondary carrier pays significantly better benefits. But ONLY a comparison of the actual plans themselves, in detail, will tell you whether it is cost effective for you to be covered on both plans. You'll want to call BCBS customer service and discuss how the two plans will work together.

 

[ajkroy]

IF she can truly be added to husband's HMO at no cost (which is a BIG benefit), then there is no loss. She should take the secondary and work out the COB. They are both BCBS policies, so they will most likely coordinate and she will have very little, if any, out of pocket expenses for the baby.

Good luck.

 

[cbg]

I have grave doubts that she can actually be added for no cost. It's rare enough for employees to get their coverage free these days. To get dependent coverage for free too? I strongly suspect that someone, somewhere is misunderstanding something.

However, I'm not trying to discourage her. Just presenting what 35+ years of administering employer-based benefits has taught me.

 

[ecmst12]

I do have a good friend who gets coverage for her whole family for free. She works for the county.