Can my Employees have Two Health Insurance Plans
Introduction
You, as an amazing team leader, care about your employees.
And, I’m sure, like everyone else, you, too, want them to have the best possible benefits. Probably that’s why you’ve recently started considering offering them an insurance plan.
However, now, you are wondering – “what if someone has more than one insurance?” Is it legal for them to have another one? Will it be ethically or morally correct too?
We’ve answered all of your questions in this article thoroughly. So, please do read till the end and let us know if you have any confusion about it below.
Does Having Two Different Plans Work?
Yes, absolutely.
Having two health insurance plans is not as complicated as it might seem. When an employee has two policies —
- One is considered the primary plan, and
- The other is the secondary plan.
1: Primary Plan
It’s the main insurance policy that pays the very first portion of the medical expenses you want it to cover. If this is your first time filing an insurance for your employees, it might be best to go for the aforementioned option.
2: Secondary Plan
The secondary plan kicks in after the primary plan pays its share. It can help cover the remaining costs, like deductibles or services not taken care of by the primary plan.
Why Should an Employee Have More than One Plan?
There are several reasons why many people want to have two different insurance plans. Let’s find out more about it.
1: Coverage Gaps
A: Specialized Care
Some health insurance plans may not cover specific specialists or treatments. For instance, a plan may not include coverage for alternative medicine practitioners, fertility treatments, or certain types of therapy.
B: Prescription Drugs
Certain prescription medications might not be fully covered by one plan, or they may not be on the formulary at all. A second plan could help cover the costs of these medications.
Note: In these cases, having a secondary plan can fill in these gaps, reducing the financial burden on the employee.
2: Spouse’s Benefits
A: Dual Income Households
In households where both partners work, each may have access to health insurance through their respective employers. This allows both individuals to be covered under their own plans.
B: Choice and Flexibility
Having two plans gives the employee the ability to choose the coverage that best suits their individual healthcare needs. They can potentially select the most beneficial aspects from each plan.
Note: In case of major medical expenses, such as surgeries or chronic illnesses, dual coverage can significantly reduce the out-of-pocket costs for the family.
3: COBRA and New Employment
A: Transition Periods
When an employee departs from a job, they might be offered the opportunity to maintain their former employer’s health coverage through COBRA for a restricted duration.
If they obtain a new position with its own health benefits during this time frame, they can also enroll in the new plan
B: Continuous Coverage
By having both plans active, employees can ensure uninterrupted healthcare coverage during the transition period. This is particularly crucial if there are ongoing medical treatments or conditions that require consistent care.
It’s worth noting that coordination of benefits rules will determine which plan pays first, potentially further reducing the employee’s out-of-pocket expenses.
4: Maximizing Benefits
A: Dental and Vision Coverage
Some employees might have separate dental and vision plans in addition to their primary health insurance. This allows them to access a wider range of services and benefits for different aspects of their healthcare.
Some Important Things to Remember
1: Notify Both Insurers for Seamless Coverage
When an employee is covered by two health insurance plans, it’s crucial to inform both insurance companies.
This ensures that they can coordinate benefits effectively. Without this information, there may be delays or confusion when it comes to processing claims.
By notifying both insurers, the employee helps create a smoother process, ultimately benefiting them in terms of receiving timely and comprehensive coverage.
2: Preserving Comprehensive Coverage
Having two insurance plans can provide a safety net, especially in cases where one plan may not cover certain treatments, medications, or procedures.
By having dual coverage, employees can ensure that a wider range of medical needs is met, reducing the likelihood of encountering gaps in coverage.
3: Periodic Review of Plans
Employees with dual coverage should periodically review their insurance plans. This helps ensure that they are still getting the best value and coverage for their specific needs.
Circumstances change, and staying informed about any updates or changes in their plans will empower employees to make informed decisions about their healthcare.
4: Claim Submission and Documentation
It’s crucial for employees to understand the process of submitting claims to both insurance companies. This may involve providing detailed documentation, including explanations of benefits (EOBs) and itemized bills from healthcare providers.
Being organized and thorough in this process helps facilitate smooth claims processing and minimizes the potential for disputes or delays.
5: Coordination of Benefits
Coordination of benefits is a key aspect of dual insurance coverage.
It entails a procedure in which the two insurance providers establish which plan takes precedence as the primary payer and which serves as the secondary payer.
This comprehension is vital for both the employee and healthcare providers to guarantee accurate claim processing. Normally, the primary plan handles the larger portion of expenses, while the secondary plan steps in to cover the remaining costs, up to the maximum allowable amount for the specific service.
The Bottom Line
Having two health insurance plans can provide extra security and financial benefits for your employees. It’s like having a safety net in case one plan doesn’t cover everything.
Just remember, having open communication with both insurers and understanding the coordination of benefits process is key.
As an employer, supporting your employees in navigating their health insurance options shows you care about their well-being. It’s a win-win situation!
Remember, always encourage your employees to consult with their insurance providers or a benefits specialist for specific guidance tailored to their individual situations.
