Question
What is the name of your state?What is the name of your state? New York
I am self-employed, and currently have an indemnity health plan for which I pay $170/month. I converted to this plan which was offered by the insurance provider of a former employer's group coverage of which I had been a part.
I also qualify for a decent (I think) PPO/POS plan through a freelancer organization in my area. Cost is ~$220/month.
My questions are:
1) Is it possible (legal) to purchase -- and be covered -- by BOTH plans?
2) What are the ramifications of doing so? Does one become primary and the other secondary? How are deductables handled?
3) Is it "reasonable" to purchase coverage under both plans. (I.e., what kind of analysis should I do to determine whether it's "worth" buying both? The combined cost of $410/month seems very reasonable compared to the $700+ Blue Cross plans in my area.)
Answer
I posted yesterday. Not here today.
Yes, you can have 2 policies, the only question is why?
From your post it seems that one policy (the indemnity plan) is a capped fee policy. As an example, one that pays up to $300 for room & board. Or up to $4,000 for surgery.
The other plan, a PPO from a "freelancer" is also suspect.
What bothers me most is your closing remark. You indicate you are paying $400 a month for something that you feel is comparable to, or better than Blue for $700 monthly. There are no deals in health insurance. There are plenty of ways to save money if you dont mind having your claims go unpaid.
Sit down with an experienced agent, preferably one who has at least 5 years in the business and represents multiple companies. Dont expect the agent to work for free. Offer to pay a consulting fee if you have no intention of buying. If you do buy, the agent will be compensated by the carrier.
Answer
Yes, it is legal to have two plans and yes, one will be primary and the other secondary.
However, contrary to what many people believe, the secondary plan will not automatically pick up whatever is left uncovered by the primary plan.
You need to fully understand what kind of coordination of benefits exist between the two plans. This is a simple example of how most plans coordinate:
You have a medical claim. You submit it to the primary carrier, who pays according to their plan.
The secondary carrier reviews the bill and determines what they would have paid had they been the primary carrier.
(a) If they would have paid the same amount, or less, than the primary carrier paid, they will pay nothing.
(b) If they would have paid more than the primary carrier did, but less than the full amount of the bill, they will pay the difference. i.e. the primary carrier paid $80, the secondary carrier, had they been primary, would have paid $90; secondary payer pays $10.
(c) ONLY if the secondary carrier would have paid the bill in full, will they pay the entire balance remaining after the primary carrier pays.
You need to determine whether the cost of the secondary policy will be outweighed by the benefits they provide.
Answer
Thanks for your reply.
<<From your post it seems that one policy (the indemnity plan) is a capped fee policy. As an example, one that pays up to $300 for room & board. Or up to $4,000 for surgery.>>
Yes, that is the case. Last year, I had an overnight stay at a hospital. The hospital billed $3,700(!!!) just for the overnight stay. The plan paid only $280. I'm still fighting with the hospital over the difference. Had I been insured with a PPO/POS plan, I feel certain the hospital would have billed a much more reasonable rate (regardless of in-network status).
I think this is one of the problems with an indemnity plan: hospitals generally consider you as "uninsured", and bill you their highest rates instead of the lower insurance company-contracted rates.
<<The other plan, a PPO from a "freelancer" is also suspect.>>
I hope it's less suspect than yuo think. The other plan is a PPO/POS plan from HIPusa. I can get in at group rates since I am a member of "freelancers union" -- $220/mo compared to $600/month for the non-group rate in my city.
I like your advice on getting an agent. Where should I turn to find a good onewho can help me compare the two plans I have in front of me now, plus show me others?
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Ah. I understand now. You example was very clear. However, I fear that truly guaging the worthiness of having two policies would require some sophisticated analysis. Oy! Maybe I should break out Excel and start a spreadsheet.
Supposing I pursue two policies, may I make a designation as to which will be primary and which secondary? Or is it determined arbitrarily by the date the coverage started, my birthdate, planet alignment, or some other uncontrollable event?
(Determining the better of the two secenarios would also require some complex analysis I imagine).
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You really need to look at what cbg had to say again, especially about COB, coordination of benefits.
And the alignment of the planets have had nothing to do with it since the 70's
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In general, the two carriers will have some formula by which they determine which is primary and which is secondary. You do not get to choose.
Enasni, glad to see you're still with us, my friend.
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In general, the two carriers will have some formula by which they determine which is primary and which is secondary. You do not get to choose.
Enasni, glad to see you're still with us, my friend.
Thanks cbg, sticking to RE... and I peeked over here. (peek)
You know your stuff here, kid, I am worried this guy will get two insurances that will not coordinate and he will be screwed!!
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You know your stuff here, kid
That's cuz not only do I have 25 years of insurance benefit experience, for five of those years I was working for a national insurance carrier. After a while it rubs off.
Drop me an e-mail if things change. Don't forget, you're welcome to join me in Employment. You-know-who hasn't been there for a while.
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You know your stuff here, kid
That's cuz not only do I have 25 years of insurance benefit experience, for five of those years I was working for a national insurance carrier. After a while it rubs off.
Drop me an e-mail if things change. Don't forget, you're welcome to join me in Employment. You-know-who hasn't been there for a while.
(peep) Will do. I am not hiding, I am just staying where I want to avoid the ugliness, It doesn't get to yucky in RE. Or here or Insurance (HMO) gets too many "visitors" and a lot of negativity.
I wanted to bring your attention to this post. I think it is a work of art, whoever this FWIW is really covered all bases on for this question. Unless you have something to add to it. I couldn't find a chink!
Ta ta...
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Link doesn't work...
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Link doesn't work...
Sorry I can't seem to get that link out of my cache... sorry. was helping someone on RE...
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Dave -
I am not familiar with hipusa. Is the same group? If so, it appears to be an HMO, not PPO/POS.
As for finding an agent, if you dont know folks who can recommend someone you can try the yellow pages. Look for display ads, and someone who represents several companies. Avoid agents who are multi-line (auto, home, life, health) and stick with those who concentrate on health insurance. Call a few and interview them over the phone. Ask how long they have been in the business, how many carriers they represent.
You can probably take it a step further and look them up on the NY DOI website.
Dont be afraid to ask questions. Make notes. Pick one or two you where there is a comfort level. Let your "gut" tell you which ones to trust.
If I knew someone in NY I would refer you but that is an area where I have not had any contacts in a number of years.
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Hmm. Wonder how I missed that thread initially.
For all practical purposes I agree. I'm not quite so sure they're in the clear by requiring retroactive payments, but I'm also not sure it would be worth the poster's while to fight it.
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<<I am not familiar with hipusa. Is the same group? If so, it appears to be an HMO, not PPO/POS.>>
HIPusa () offers HMO, PPO and POS plans. I am considering either the PPO or POS.
Thanks for your suggestions on finding an agent. Maybe a single policy is the best course, since coordination of benefits seems to be fraught with complexities. I guess I just need to determine which plan is better: my current indemnity policy or the HIP POS plan I am considering.
Does anyone have any thoughts on indemnity plans in general?Are they generally more or less desirable than POS plans, and why?