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Coordination of Benefits with Multiple insurance plans?

NiSn

Hero Member
Mar 17, 2018
209
32
a) I am covered under Group Health insurance policy with my employer & have my wife as dependent. The policy covers dental expenses upto $2K per year.
b) My wife is also covered under a Group health insurance policy with her employer & a different service provider. Her policy does not cover dental care directly but has a healthcare savings account which can be used to reimburse Dental expenses

My wife requires a Dental visit. I have following questions -
1) Is it mandatory to file claim first with her insurance policy through her employer? Since dental is not covered, does it mean we just get the reimbursement done? Or is there a way we can directly apply for claim under my policy where she is dependent
2) Is it mandatory to inform service providers about the other coverage policies? What if I dont share details about my spouse's insurance policy to the Group health plan under my employer where she is dependent and apply directly for the claim?
 

Copingwithlife

VIP Member
Jul 29, 2018
3,939
1,903
Earth
a) I am covered under Group Health insurance policy with my employer & have my wife as dependent. The policy covers dental expenses upto $2K per year.
b) My wife is also covered under a Group health insurance policy with her employer & a different service provider. Her policy does not cover dental care directly but has a healthcare savings account which can be used to reimburse Dental expenses

My wife requires a Dental visit. I have following questions -
1) Is it mandatory to file claim first with her insurance policy through her employer? Since dental is not covered, does it mean we just get the reimbursement done? Or is there a way we can directly apply for claim under my policy where she is dependent
2) Is it mandatory to inform service providers about the other coverage policies? What if I dont share details about my spouse's insurance policy to the Group health plan under my employer where she is dependent and apply directly for the claim?
You should not be with holding any information regarding coverage you have with any other insurance companies
 

canuck78

VIP Member
Jun 18, 2017
52,969
12,768
a) I am covered under Group Health insurance policy with my employer & have my wife as dependent. The policy covers dental expenses upto $2K per year.
b) My wife is also covered under a Group health insurance policy with her employer & a different service provider. Her policy does not cover dental care directly but has a healthcare savings account which can be used to reimburse Dental expenses

My wife requires a Dental visit. I have following questions -
1) Is it mandatory to file claim first with her insurance policy through her employer? Since dental is not covered, does it mean we just get the reimbursement done? Or is there a way we can directly apply for claim under my policy where she is dependent
2) Is it mandatory to inform service providers about the other coverage policies? What if I dont share details about my spouse's insurance policy to the Group health plan under my employer where she is dependent and apply directly for the claim?
You can use multiple insurance plans (one as primary and the other one as secondary) but you must only claim the amount that is not covered by the first insurance plan when claiming any services on the second policy. If you claimed the full amount to both you would receive more than you paid and that would be insurance fraud.
 

scylla

VIP Member
Jun 8, 2010
92,916
20,531
Toronto
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a) I am covered under Group Health insurance policy with my employer & have my wife as dependent. The policy covers dental expenses upto $2K per year.
b) My wife is also covered under a Group health insurance policy with her employer & a different service provider. Her policy does not cover dental care directly but has a healthcare savings account which can be used to reimburse Dental expenses

My wife requires a Dental visit. I have following questions -
1) Is it mandatory to file claim first with her insurance policy through her employer? Since dental is not covered, does it mean we just get the reimbursement done? Or is there a way we can directly apply for claim under my policy where she is dependent
2) Is it mandatory to inform service providers about the other coverage policies? What if I dont share details about my spouse's insurance policy to the Group health plan under my employer where she is dependent and apply directly for the claim?
1) Normally yes. Call your insurance company and ask them what your options are. Speaking with them is the best way to handle this.
2) Absolutely mandatory to disclose. Failure to do so is classified as fraud and can result in a permanent loss of your benefits coverage. Don't mess around with this.
 
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