I was wondering how have two health insurance policies works within the following (very specific) case. Read below roughly details:
1) Child has Autism.
2) Father's current insurance plan may not cover behavioral dream therapy for autism, which is very expensive.
3) State of residence (Indiana) have a mandate that employer-based insurance policies cover behavioral therapy for Autism.
4) Father's employer is not subject to mandate because its headquarters is out-of-state.
We are considering getting the Mother a charge, with insurance, specifically in-state and subject to the mandate specifically so this therapy is covered. Individual insurance will not work because this is a preexisting conditition, so group insurance is required.
However, the second policy would result contained by us being double insured. The father cannot waive his insurance until the subsequent open enrollment extent in January.
How does double insurance work within this case?
Answers: I agree beside the other posters about the state mandate. They are obligated to follow state law if they operate a business in that state. You should own this point clarified by your state's insurance department and get something surrounded by writing from your employer's insurance.
The birthday rule generally applies for children. Whichever parent's birthday comes first surrounded by the calandar year is primary for the child. ( The parent's birth year is not important).
Example:Father's birthday is 2/19
Mother's birthday is 5/21
Father would be primary, mother would be secondary. If father's insurance denies, later that EOB is forwarded to the secondary and the lesser considers the claim for payment. If primary pays something on the claim, subsidiary will usually only pick up the go together to the maximum amount they would have compensated as primary.
no One insurance would be the primary and the other would be the secondary..
If you are getting the mother to work to cover this hard to please condition, I would not even MENTION that your child has another insurance policy when it regard getting treated for this particular issue.
Since your wife is going to work for this, it might be a right idea to research respectively of the plans to see which insurance is better..I do believe that Father should check with an attorney (free consultation) since I would be curious if father employer was contained by violation of the tenet (headquarters out of state is no excuse.when doing business in Indiana, Indiana's rules and regulations should apply)
I would disagree beside point #4. If there are operation in your state, the company have to comply with the requirements of that state. I would folder a complaint to your state insurance department (because your HEALTH INSURANCE policy is issued in that state! Because insurance is regulated on a state by state proof!).
Mom's policy is primary for mom. Dad's policy is primary for dad. The two insurance companies fight it out, over who is primary for the kids. But I don't chew over it's going to come to that - see paragraph #1.
Pre-existing conditions only come into play when you hold had a lapse contained by coverage. If the child was continually covered lower than the father then it wouldnt apply. The insurance merely wants to be sure that you are hoarding illnesses and after getting them all cured the light of day you get insurance. If you show continued coverage afterwards they assume you are being treated right along.
I process subsidiary claims for BCBS. If the primary payor (insurance) doesnt cover something as long as its a benefit under the 2nd plan after the 2nd plan will pay as primary. You're DR will a short time ago need to submit a copy of the denied explination of benefits (EOB) from the primary when they directory their secondary claims.
I WOULD NOT ADVISE that you hold on to his condition a secret, especially if his coverage never lapsed. We also process coordination-of-benefits-recovery here and you don't want a $40,000 repayment letter because the insurance finds out down the road you did own another carrier and they salaried out of order(they have ways of finding out/cob cross-overs etc). At that point it get sticky because plans only allow you to report claims for a certain amount of time and once the 2ndary get their money back its usually too behind time to refile to the right payor (to get the proper denial anyway).
I hope this help and best of luck..
1) Child has Autism.
2) Father's current insurance plan may not cover behavioral dream therapy for autism, which is very expensive.
3) State of residence (Indiana) have a mandate that employer-based insurance policies cover behavioral therapy for Autism.
4) Father's employer is not subject to mandate because its headquarters is out-of-state.
We are considering getting the Mother a charge, with insurance, specifically in-state and subject to the mandate specifically so this therapy is covered. Individual insurance will not work because this is a preexisting conditition, so group insurance is required.
However, the second policy would result contained by us being double insured. The father cannot waive his insurance until the subsequent open enrollment extent in January.
How does double insurance work within this case?
Answers: I agree beside the other posters about the state mandate. They are obligated to follow state law if they operate a business in that state. You should own this point clarified by your state's insurance department and get something surrounded by writing from your employer's insurance.
The birthday rule generally applies for children. Whichever parent's birthday comes first surrounded by the calandar year is primary for the child. ( The parent's birth year is not important).
Example:Father's birthday is 2/19
Mother's birthday is 5/21
Father would be primary, mother would be secondary. If father's insurance denies, later that EOB is forwarded to the secondary and the lesser considers the claim for payment. If primary pays something on the claim, subsidiary will usually only pick up the go together to the maximum amount they would have compensated as primary.
no One insurance would be the primary and the other would be the secondary..
If you are getting the mother to work to cover this hard to please condition, I would not even MENTION that your child has another insurance policy when it regard getting treated for this particular issue.
Since your wife is going to work for this, it might be a right idea to research respectively of the plans to see which insurance is better..I do believe that Father should check with an attorney (free consultation) since I would be curious if father employer was contained by violation of the tenet (headquarters out of state is no excuse.when doing business in Indiana, Indiana's rules and regulations should apply)
I would disagree beside point #4. If there are operation in your state, the company have to comply with the requirements of that state. I would folder a complaint to your state insurance department (because your HEALTH INSURANCE policy is issued in that state! Because insurance is regulated on a state by state proof!).
Mom's policy is primary for mom. Dad's policy is primary for dad. The two insurance companies fight it out, over who is primary for the kids. But I don't chew over it's going to come to that - see paragraph #1.
Pre-existing conditions only come into play when you hold had a lapse contained by coverage. If the child was continually covered lower than the father then it wouldnt apply. The insurance merely wants to be sure that you are hoarding illnesses and after getting them all cured the light of day you get insurance. If you show continued coverage afterwards they assume you are being treated right along.
I process subsidiary claims for BCBS. If the primary payor (insurance) doesnt cover something as long as its a benefit under the 2nd plan after the 2nd plan will pay as primary. You're DR will a short time ago need to submit a copy of the denied explination of benefits (EOB) from the primary when they directory their secondary claims.
I WOULD NOT ADVISE that you hold on to his condition a secret, especially if his coverage never lapsed. We also process coordination-of-benefits-recovery here and you don't want a $40,000 repayment letter because the insurance finds out down the road you did own another carrier and they salaried out of order(they have ways of finding out/cob cross-overs etc). At that point it get sticky because plans only allow you to report claims for a certain amount of time and once the 2ndary get their money back its usually too behind time to refile to the right payor (to get the proper denial anyway).
I hope this help and best of luck..