Indianaflash
Junior Member
What is the name of your state? Indiana
Even the insurance companies don't seem to be able to figure out deductibles, co-pays, Max O.O.P.'s, and -at this point- maybe which is primary or secondary coverage. I need advice on how it technically/legally should work.
Due to unusual circumstances, I had COBRA & another medical Insurance during the 4th Qtr of 2007. (COBRA election reasons and circumstances provided as needed)
Insurance #1 was a HDHP and effective from 4/15/07 through 10/15/07 and the COBRA coverage that I elected (and paid for) through 12/31/07. She did not elect the COBRA coverageDetails: I was secondary/Spouse insured on my wife's (family) policy at her work.
Deductible 3000, Max OOP 6000, most Co-pays at 20%. We had met the annual max OOP and all (covered) claims were being paid at 100%.
My wife (primary insured) changed jobs but the new (family) HDHP Insurance #2 would not be effective until 10/28/07. The new HDHP (#2) was paid 100% by employer so she elected family coverage for the remaider of the year because:
1) They also contributed some to our HSA.
2) WE could get family coverage without pre-existing conditions under HIPPA.
Insurance #2 HDHP effective 10/28/07 thru 12/31/07
Individual/family deductibe 4000, Max individaul OOP 4500, Max family OOP 8000. (Plan was written incorrectly, but enforced - Changed for 2008 with no individual Max OOP!). I was secondary/spouse on this policy also. My wife started off having met max OOP for year (unusual circumstances) and I started off paying only co-pays.
I (only) elected COBRA coverage in November with insurance #1 after it was confirmed that we had family coverage with insurance #2. The COBRA (continuation) coverage effective date with Ins #1 was 10/16/07. (no lapse in coverage (for me))
Finally in Late Dec. my COBRA coverage with Ins #1 was activated and started paying claims back to 10/16/07 but they assigned me a new Account# ,made me Primary, and started me at zero, i.e., I had to pay 1500 deductible (now a single plan) and I then paid 20%co-pay till years end. I was told by Insurance #1 (in October) that deductibles and Co-pays and max OOP accumulated before COBRA election would be carried into the COBRA election period, but they did not.(they are researching that!) I believe that they should have paid at 100%.Should they?
And what will Ins#2 pay(when filed) if COBRA ins#1 does not have to pay at 100%?
TOLD YOU THIS WOULD BE A CHALLENGE!What is the name of your state?
Even the insurance companies don't seem to be able to figure out deductibles, co-pays, Max O.O.P.'s, and -at this point- maybe which is primary or secondary coverage. I need advice on how it technically/legally should work.
Due to unusual circumstances, I had COBRA & another medical Insurance during the 4th Qtr of 2007. (COBRA election reasons and circumstances provided as needed)
Insurance #1 was a HDHP and effective from 4/15/07 through 10/15/07 and the COBRA coverage that I elected (and paid for) through 12/31/07. She did not elect the COBRA coverageDetails: I was secondary/Spouse insured on my wife's (family) policy at her work.
Deductible 3000, Max OOP 6000, most Co-pays at 20%. We had met the annual max OOP and all (covered) claims were being paid at 100%.
My wife (primary insured) changed jobs but the new (family) HDHP Insurance #2 would not be effective until 10/28/07. The new HDHP (#2) was paid 100% by employer so she elected family coverage for the remaider of the year because:
1) They also contributed some to our HSA.
2) WE could get family coverage without pre-existing conditions under HIPPA.
Insurance #2 HDHP effective 10/28/07 thru 12/31/07
Individual/family deductibe 4000, Max individaul OOP 4500, Max family OOP 8000. (Plan was written incorrectly, but enforced - Changed for 2008 with no individual Max OOP!). I was secondary/spouse on this policy also. My wife started off having met max OOP for year (unusual circumstances) and I started off paying only co-pays.
I (only) elected COBRA coverage in November with insurance #1 after it was confirmed that we had family coverage with insurance #2. The COBRA (continuation) coverage effective date with Ins #1 was 10/16/07. (no lapse in coverage (for me))
Finally in Late Dec. my COBRA coverage with Ins #1 was activated and started paying claims back to 10/16/07 but they assigned me a new Account# ,made me Primary, and started me at zero, i.e., I had to pay 1500 deductible (now a single plan) and I then paid 20%co-pay till years end. I was told by Insurance #1 (in October) that deductibles and Co-pays and max OOP accumulated before COBRA election would be carried into the COBRA election period, but they did not.(they are researching that!) I believe that they should have paid at 100%.Should they?
And what will Ins#2 pay(when filed) if COBRA ins#1 does not have to pay at 100%?
TOLD YOU THIS WOULD BE A CHALLENGE!What is the name of your state?