Is there any state mandate of how a primary and secondary health insurance are required to coordinate services?
This depends on the state. We are not familiar with the coordination of benefits regulations in all states. We can try to research this for you, or provide you with some suggestions on where to get your answers. Are you interested in the regulations for a specific state?
5 Comments
Thanx for the reply. Yes, it is a state. I live in NC and have BCBSNC and BCBSFL. So I was using my BCBS Florida as primary and BCBS North Carolina as secondary. So far, there has been no benefit to having two policies. I am disabled and the BCBSFL is Cobra offered from my previous job. Cobra runs out in the next couple of months. It is $459/month for individual. The BCBSNC is thru my wife’s employer and I am covered under spouse. I was considering seeing about continuing the BCBSFL, post COBRA, if the price was reasonable. The coverage is a little better than BCBSNC. Hope that helps. Maybe made it more confusing.
Comment by Steve — February 27, 2007 @ 7:13 pm
There usually is not a benefit in maintaining duel health insurance policies, especially if you are paying for both of them. If your wife’s employer pays 100% of the dependent’s premium, it makes more sense. However, since you have been paying $459 to maintain your COBRA with BCBSFL, you probably would have been further ahead canceling that and using BCBSNC as your primary. The only time that wouldn’t make sense is if there was such a difference in the two policies that your coinsurance and co-payments through the BCBSNC policy exceeded $459 per month, which is probably unlikely.
You will need to make the same analysis when you look at “post COBRA” coverage with BCBSFL when your COBRA expires. You might want to check with BCBSFL now to make sure that a conversion plan is even available to you, since you are now a resident of NC. A conversion plan is when BCBSFL takes your group coverage under COBRA and converts it into an individual health plan. The premiums are usually very high on conversion plans and there is often times a reduction in benefits. It’s wise to check into this option well in advance of losing your COBRA, but less of an issue since you have back-up coverage with BCBSNC. Since you now live in NC, this option may not even be available to you.
Your initial inquiry regarding coordination of benefits is further complicated by the fact that you have insurance policies issued from 2 different states, each regulated by separate state laws. The best source to get confirmation on what to expect in the case of a need for coordination of benefits would be BCBSNC. Since they are the secondary insurer, they may be responsible for items not covered by BCBSFL, but since BCBSFL provides you with the more comprehensive coverage, the likelihood of BCBSNC covering something that is not covered by BCBSFL could be rare.
In California, what is the secondary provider required to pay? My insurance provider through a small employee group, DOB June. My husband’s provide by employer works in California headquarters in TX, DOB July.
Comment by slo3sons — March 12, 2009 @ 4:08 pm
what is the law on the coordination of health benefits in New York State? What is the federal law? Who is primary and who is secondary?
Thank You.
Comment by ds — May 21, 2009 @ 12:37 pm
I am getting confused about primary and secondary health insurance laws and how they work together. Mu daughter is currently covered under my policy, which is a very good plan from Cigna Health, but that is apparently her secondary plan as I understand it. Her primary health plan is with her father. We are divorced and he has some kind of health plan where the payments are taken from a set fund at the beginning of the year, so if she goes to the ER and gets billed $1000 that may actually wipe out that plan for the rest of the year. I am not sure what type of plan that is. Wouldn’t it be better for my daughter if she used my plan as her primary health insurance? Then perhaps she could pay for the copay on my plan with her fathers plan, is that possible?
Is there any state mandate of how a primary and secondary health insurance are required to coordinate services?
This depends on the state. We are not familiar with the coordination of benefits regulations in all states. We can try to research this for you, or provide you with some suggestions on where to get your answers. Are you interested in the regulations for a specific state?
Thanx for the reply. Yes, it is a state. I live in NC and have BCBSNC and BCBSFL. So I was using my BCBS Florida as primary and BCBS North Carolina as secondary. So far, there has been no benefit to having two policies. I am disabled and the BCBSFL is Cobra offered from my previous job. Cobra runs out in the next couple of months. It is $459/month for individual. The BCBSNC is thru my wife’s employer and I am covered under spouse. I was considering seeing about continuing the BCBSFL, post COBRA, if the price was reasonable. The coverage is a little better than BCBSNC. Hope that helps. Maybe made it more confusing.
Comment by Steve — February 27, 2007 @ 7:13 pm
There usually is not a benefit in maintaining duel health insurance policies, especially if you are paying for both of them. If your wife’s employer pays 100% of the dependent’s premium, it makes more sense. However, since you have been paying $459 to maintain your COBRA with BCBSFL, you probably would have been further ahead canceling that and using BCBSNC as your primary. The only time that wouldn’t make sense is if there was such a difference in the two policies that your coinsurance and co-payments through the BCBSNC policy exceeded $459 per month, which is probably unlikely.
You will need to make the same analysis when you look at “post COBRA” coverage with BCBSFL when your COBRA expires. You might want to check with BCBSFL now to make sure that a conversion plan is even available to you, since you are now a resident of NC. A conversion plan is when BCBSFL takes your group coverage under COBRA and converts it into an individual health plan. The premiums are usually very high on conversion plans and there is often times a reduction in benefits. It’s wise to check into this option well in advance of losing your COBRA, but less of an issue since you have back-up coverage with BCBSNC. Since you now live in NC, this option may not even be available to you.
Your initial inquiry regarding coordination of benefits is further complicated by the fact that you have insurance policies issued from 2 different states, each regulated by separate state laws. The best source to get confirmation on what to expect in the case of a need for coordination of benefits would be BCBSNC. Since they are the secondary insurer, they may be responsible for items not covered by BCBSFL, but since BCBSFL provides you with the more comprehensive coverage, the likelihood of BCBSNC covering something that is not covered by BCBSFL could be rare.
Comment by admin — February 27, 2007 @ 7:15 pm
In California, what is the secondary provider required to pay? My insurance provider through a small employee group, DOB June. My husband’s provide by employer works in California headquarters in TX, DOB July.
Comment by slo3sons — March 12, 2009 @ 4:08 pm
what is the law on the coordination of health benefits in New York State? What is the federal law? Who is primary and who is secondary?
Thank You.
Comment by ds — May 21, 2009 @ 12:37 pm
I am getting confused about primary and secondary health insurance laws and how they work together. Mu daughter is currently covered under my policy, which is a very good plan from Cigna Health, but that is apparently her secondary plan as I understand it. Her primary health plan is with her father. We are divorced and he has some kind of health plan where the payments are taken from a set fund at the beginning of the year, so if she goes to the ER and gets billed $1000 that may actually wipe out that plan for the rest of the year. I am not sure what type of plan that is. Wouldn’t it be better for my daughter if she used my plan as her primary health insurance? Then perhaps she could pay for the copay on my plan with her fathers plan, is that possible?
Comment by Maria — June 11, 2009 @ 12:49 am