What are the rules with dual coverage in regards to
COBRA for the husband & a group plan for wife?
The Primary (person A)
***[How do I know, who is primary? I need to see the documents]
If you are covered as an employee, member or subscriber under more than one plan, but are covered under state or federal continuation (COBRA) under one of the plans, then:
The plan covering you as an employee, member or subscriber is primary over the plan covering you under state or federal continuation (COBRA). illinois.gov
has health insurance through their job, loses job, continues COBRA coverage for the family, meets the maximum deductible of $4000, [individual and/or family deductible] they have 0% out of pocket expenses now except for the monthly premium of $1,442.
Mid-year the spouse (person B) now gets a job with health insurance coverage through their employer.
The premium is much less $338, deductible of $3,000 with 80% coverage for in-network.
If they cancel the COBRA, then they pay a new deductible +20% of medical charges incurred. If they overlap and have dual-coverage, then they are really paying extra money for the second medical plan $338/month with little benefit
***I don’t quite follow, sounds like more benefit
-since they’ve met their deductible and pay 0% out of pocket.
What if the family has dual coverage for 1 month, then after the second month they cancel COBRA?
Do they still have to meet the new deductible of $3,000?
***I’d have to see the new policy. I doubt there is any take over provision. Thus, yes.
Does the insurance company only look at charges that have occurred within that month of dual coverage in order to determine if deductible B $3,000 has been met?
***Deciding what medical bills go to the deductible has nothing to do with having other coverage.
How do they determine when it’s beneficial to have dual coverage?
***The Insurance Company doesn’t decide if it’s better for you. That’s your decision. Why pay $1,442 to have dual coverage? In two months, you have the $3k deductible taken care of. Also, the $338 contribution as the employer is paying the rest of the premium, is probably tax deductible, if the employer has set up a Section 125 POP Plan.