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dupliczate benefits?

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bowler87

Guest
What is the name of your state? Nebraska.
My group health plan paid for most of my medical expenses following an accident. When they discovered that I also carried
a supplemental accident policy(which pays maximum of $500) they said that they want to be reimbursed. The health plan contract says nothing about being reimbursed from a supplemental accident policy. They say there is a statute in Nebraska that prohibits collecting on my group health AND other insurance sources. Is there? Or are they just bluffing?
What is the statute?
 


cbg

I'm a Northern Girl
I don't know Nebraska statutes specifically, but I don't know of any state that will allow you to collect more than the amount of the bill, if that's what you're asking. At most, the two coverages would coordinate to pay the bill in full, but you don't get to have both coverages pay and pocket the difference. So if the one has paid the bill in full, but the other coverage should have paid part of it, yes, they can ask for reimbursement.

There's also in insurance a thing called primary and secondary coverage. Without seeing the policies I couldn't tell you which of your policies is supposed to be primary, but if the supplemental policy is primary then they are supposed to pay first. The health insurance policy, assuming it allows for coordination of benefits (most of them do, but unless Nebraska has something quirky I don't believe they're required to by law) would then pick up a portion of the balance.

Sorry I can't be more specific. I've worked with group health insurance plans for many, many years but I've never happened to have employees in Nebraska.

If I'm misinterpreting the question, please post back and clarify.
 
B

bowler87

Guest
COB does not apply to individual coverage.

The term "PRIMARY" does not appear in either policy.

Why would the auto industry sell med pay coverage if the benefits just went to the group plan? Kinda like buying insurance that a dinosaur will not step on your lawn---no claims!

If you have agroup health plan and spouse has individual maj med with Mutual of Omaha, and you have a supplemental $500 accidnet policy with Provident--then all three should pay without regard to the payments of the other.

The situation of PRIMARY is not mentioned in group policy--they just ASSUME it. So I thought it may have been a statute.

Group policy will ask for reimbursement from DAMAGES (that come from tortfeasor) or COB with another group, but they can not just take my benefits without a clause(or statute) allowing them to do so, can they?
 

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