 Question
What are my options for buying health insurance for me or my family?
Answer
A good way to get health insurance is through your employer as part of a "group health insurance" plan. You will often have broader benefits and pay less than if you were to buy a plan yourself on the open market. There are health plans now, which consider people who are self-employed to be a "group of one," and will offer you group coverage.
See if you can get a group policy through some other channel, if you don't have access to an employer-sponsored health plan. Frequently, local chambers of commerce or professional organizations offer group health insurance to their members. If you can't obtain group coverage anywhere, you can still buy individual coverage, but the rates will be higher and you risk being turned down for coverage if you have any pre-existing medical conditions.
Frequently, health plans will have "open enrollment" periods, an annual window period when individuals can join. You may have to wait until next year, if you missed open enrollment. Get to know if your state's insurance department has a health insurance shopper's brochure that lists health plans and comparative costs. Clear up if your state mandates any "guaranteed issue" plans for individuals.
Question
I and my husband both have health insurance concurrently. Because he was born earlier in the year I believe that my husband's policy is primary. His insurance company says that this would be the case only for children. Both insurers are telling that the other is the primary carrier.
Can you help me convince my husband's carrier that it is primarily responsible for the claims?
Answer
Your health plan can describe how it coordinates benefits with other plans. Your benefits handbook should spell out the procedure for coordination of benefits (COB) — or whether your plan simply doesn't have such a procedure. COB is a widely practiced industry standard, it's not a law. The "birthday rule" to which you refer usually applies only to children.
Harmonization of benefits can be complicated, especially if you have one type of plan, such as an indemnity plan, and your spouse has an HMO. Read how COB generally works when you and your spouse are covered under each other's plan:
The primary plan pays your claims as if there were no secondary insurance. The secondary plan then pays for what the primary plan didn't, but only as long as the medical treatment or services are covered benefits under that plan. For instance, if your visit to the doctor cost $50 and your primary plan pays $30 of that, your secondary plan would pay the remaining $20 (if the benefits are covered). Remember, the plans will not pay more than 100 percent of the cost of treatment, nor will they pay for treatment that isn't covered.
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