Question
What is the name of your state? Texas
I retired from the Government and kept my BC/BS coverage for me and my family. I took another job with an organization with group coverage that is provided free for the employee. This group plan has high co-pays and deductibles (2 or 3 times BC/BS). I have been told that the Group Plan has to be primary since it is from my current employer and I have to use this plan for prescriptions, etc. BC/BS says that they do not coordinate co-pays and deductions and that it appears that I will be stuck paying for lots more of my medical expenses with the Group Plan as my Primary. I went to my employer to try and opt out and they say that I can't because it is in their contract with the Plan that all employees be covered. Both insurers say I must legally divulge the coverage by both. Is there any legal way to decline the Group Plan and just use BC/BS as my Primary and one and only? Thanks for your help. LindaWhat is the name of your state?
Answer
Unfortunately, no. If there were a cost to you for the group plan you could opt to decline it and your employer would be required to let you, but where the plan is free to employees your employer can require you to participate (and the plan is very likely contingent on 100% participation). You cannot require either plan to consider BC/BS your primary carrier, either; that's determined by the policies.
All I can suggest is that you ask your employer whether or not they will permit you to waive participation in the group plan if you can provide proof of other coverage (sometimes they will). But since there is no cost to you for participating, they can legally say no.
Answer
If you have a $20 copay for your primary plan but a $10 for the secondary, then your secondary plan *should* reimburse you the difference if you submit the claim to them. What is the reason that they won't do that?
Answer
You should be using both of your insurances when you go to the doctor, pharmacy, etc. You have a primary and a secondary. Your main concern I believe was the pharmacy benefit. The pharmacy should run prescriptions through on your primary first and then your secondary. The same goes for doctor visits, etc. They submit to the primary first and then to the secondary. It is very likely that with both insurances you will have very little out of pocket.
Answer
Just don't make the mistake of believing that a secondary carrier is always going to pick up anything not covered by the primary carrier. That's not the way it works.
But since your secondary carrier has the better benefits, you'll get more out of having two coverages than if it were the other way around. The ONLY time it makes sense to have two insurance plans is if the secondary plan has better coverage.