How does it work if you have 2 health insurance policies?

[HannaAddict]

And meant to say congratulations too! Our vision for adults is part of the regular medical plan and dental for kids is too - part of the affordable care act changes and requirements. Not sure with an HMO but they might be bundled with the medical. And our vision with the Cadillac plan was a whopping $150 toward contacts or glasses (and basic exam).

[Liziz]

You want to research the "coordination of benefits" provisions for the plans. Almost all plans have COB rules -- most match the NAIC rules laid out here (http://www.naic.org/store/free/MDL-120.pdf ... I just skimmed but I think this is the most recent version). Basically, when you have two insurance plans, there's always a "primary" plan and a "secondary" plan. You don't get to pick how which is used. If your husband has coverage as an employee through his work, and as a dependent through your plan, his plan would be primary for him, always -- he can't pick and choose between using the PPO coverage for some providers and the HMO coverage for others. In most circumstances then, the primary plan acts as though the secondary plan doesn't exist -- and then the secondary plan would kick in for any potential out of pocket expenses that that primary plan didn't cover (coinsurance, deductibles, etc.), after the primary plan has paid. Your DH would tell insurance providers about both insurances he carries when he schedules/goes to an appointment.

ETA: I went back and read your original question again -- in short, my answer to you would be that if there is no cost (and you don't get an added benefit by keeping him off) to add DH to your HMO plan, and there should be no downside. As long as DH is actively employed and carries his own PPO coverage, you could never be worse off with him having 2 plans -- and at times could be better off, as the secondary plan might cover some of the out of pocket expenses of the primary plan.

..and one final note, if you want DS on your HMO plan, make sure to get him off off DH's plan -- because again, you wouldn't get to pick which of the 2 plans (yours or DH's) would be primary for your son if you keep him on both -- in general, it would default to the plan of whichever parent has a birthday earlier in the year (not age, but birth month in the calendar year). I know you're not planning on this but just wanted to caution you because I've seen people get messed up by it!

[niccig]

So you got the job????

Yes. They had an offer already written when I went for the interview. There's a shortage of SLPs in my area, so if you have the degree, have a pulse and aren't an idiot, you're employed - There's 100% employment rate from my program.

This isn't the smaller district I was talking about a few weeks back, as I was advised against that by a local SLP. My job will be with a larger district, as they have better pay/benefits and training program if new to the district, plus I know several people working there from my program and they all support each other. It's not 100% ideal, but it fits more checkboxes than other positions/settings right now. When I get more experience, I can look elsewhere if I want. The hospital where I did my internship said they would hire me PRN for 1 Saturday/month when I get my CCCs, so I'll look into doing that then to keep up some of those skills. I would love to work there, but their schedule is really tough with DS and they don't have any jobs open anyway.

[niccig]

..and one final note, if you want DS on your HMO plan, make sure to get him off off DH's plan -- because again, you wouldn't get to pick which of the 2 plans (yours or DH's) would be primary for your son if you keep him on both -- in general, it would default to the plan of whichever parent has a birthday earlier in the year (not age, but birth month in the calendar year). I know you're not planning on this but just wanted to caution you because I've seen people get messed up by it!

Thanks for all of this, very helpful. One question about DS - if he's still on DH's plan for a couple of months, and I take him to Dr. that only accepts HMO, wouldn't that be the insurance used? DH's birthday is before mine, so DH's would be primary, but if the Dr. only takes the secondary insurance, wouldn't that be used? Just trying to work out all the ins and outs.

We could always take DS and I off DH's when I start work in August, try out the new doctors, and if not happy, then have DH put us back on in November to start in January for the next open enrollment. I just want to be able to go back if we're not happy...though we could stick it out for over a year as so rarely use the dr.

[Liziz]

Thanks for all of this, very helpful. One question about DS - if he's still on DH's plan for a couple of months, and I take him to Dr. that only accepts HMO, wouldn't that be the insurance used? DH's birthday is before mine, so DH's would be primary, but if the Dr. only takes the secondary insurance, wouldn't that be used? Just trying to work out all the ins and outs.

I would speak with the doctor's office and the insurance carrier, but not necessarily. Primary vs. Secondary plan determination isn't based on which insurances a particular office accepts. When you say "only accepts the HMO" - do you mean "is not in-network with the PPO" or do you mean "will not file to plans other than the HMO"? If you mean "is not in-network with the PPO" then PPO would still be primary, but it would be treated as an out of network provider visit -- generally (not always, but often on a PPO) covered to some degree, but at a much higher out of pocket cost to you than an in-network provider. If you mean "will not file to plans other than the HMO", then that office would likely not file ANY claim to insurance (as DH's plan would still be primary), and you would have to file the claim to the PPO yourself if you were hoping to get any insurance payment on it.

As a note: if you're wondering, I know people intentionally withhold insurance info to "play" with the primary vs. secondary (i.e. - bring DS to the doc that only accepts the HMO, and just not tell them that DS is also covered on DH's PPO) -- but I would personally never do that, because if either insurance company finds out, you could easily lose benefits from BOTH plans and risk having previously paid claims revoked (which leaves you responsible for the full bill). Most member agreements require you to disclose all insurance coverages (again, best to read plan documents carefully, but that's in general...)

[niccig]

I would speak with the doctor's office and the insurance carrier, but not necessarily. Primary vs. Secondary plan determination isn't based on which insurances a particular office accepts. When you say "only accepts the HMO" - do you mean "is not in-network with the PPO" or do you mean "will not file to plans other than the HMO"? If you mean "is not in-network with the PPO" then PPO would still be primary, but it would be treated as an out of network provider visit -- generally (not always, but often on a PPO) covered to some degree, but at a much higher out of pocket cost to you than an in-network provider. If you mean "will not file to plans other than the HMO", then that office would likely not file ANY claim to insurance (as DH's plan would still be primary), and you would have to file the claim to the PPO yourself if you were hoping to get any insurance payment on it.

As a note: if you're wondering, I know people intentionally withhold insurance info to "play" with the primary vs. secondary (i.e. - bring DS to the doc that only accepts the HMO, and just not tell them that DS is also covered on DH's PPO) -- but I would personally never do that, because if either insurance company finds out, you could easily lose benefits from BOTH plans and risk having previously paid claims revoked (which leaves you responsible for the full bill). Most member agreements require you to disclose all insurance coverages (again, best to read plan documents carefully, but that's in general...)

I meant the Dr. only files to HMO insurance. I'm pretty sure we're going to take both DS and I off DH's insurance and go onto mine when I can. I'll put DH on the HMO too, but he'll keep his PPO and Dr. for now. He's in the middle of tests/working out medication and I don't want to mess with that when DH is covered at his work.

Thanks Lizi, I didn't know that DS's primary would be based on who has earlier birthday, that's DH and not me.