I’ve looked through reddit and a couple of websites and understand how dual coverage’s coordination of benefits work when it comes to deductibles calculation, but wonder if things will be different when it comes to out of pocket maximum calculation. Thanks for reading in advance!
I am currently on my husband’s health insurance until next March 31, and will then join my own employer’s insurance effective January 1 next year. My understanding is that, effective from January 1, my own employer’s insurance (Cigna) will become my primary insurance and my husband’s (UHC) will become my secondary insurance. My primary/Cigna plan will have a Out-of-Pocket Maximum (MOOP) of $3000. (Is this correct?)
I am due next March with an expected medical bill likely in the $30k-50k, exceeding my primary’s MOOP.
I have already met my current insurance (UHC)’s deductible (which has a 70% coinsurance), will my secondary (UHC) plan kick in to help pay portion of the $3000? My understanding is that once my primary (has a 80% co-insurance) has paid and allocated $3000 MOOP to be my own patient responsibility, my secondary insurance will still come in to help with paying 70%*3000=$2100, and the amount my secondary insurance paid does not go back to be reported to the primary insurance, so that Cigna still count me as meeting my MOOP for the year. Is this correct?
In effect, the actual amount I will pay out-of-own pocket will be $900 in this ($3000 MOOP allocated by my primary – $2100 by my secondary), while my $3000 MOOP is met?
Thank you!
submitted by /u/firstandlastbar
[link] [comments]I’ve looked through reddit and a couple of websites and understand how dual coverage’s coordination of benefits work when it comes to deductibles calculation, but wonder if things will be different when it comes to out of pocket maximum calculation. Thanks for reading in advance! I am currently on my husband’s health insurance until next March 31, and will then join my own employer’s insurance effective January 1 next year. My understanding is that, effective from January 1, my own employer’s insurance (Cigna) will become my primary insurance and my husband’s (UHC) will become my secondary insurance. My primary/Cigna plan will have a Out-of-Pocket Maximum (MOOP) of $3000. (Is this correct?) I am due next March with an expected medical bill likely in the $30k-50k, exceeding my primary’s MOOP. I have already met my current insurance (UHC)’s deductible (which has a 70% coinsurance), will my secondary (UHC) plan kick in to help pay portion of the $3000? My understanding is that once my primary (has a 80% co-insurance) has paid and allocated $3000 MOOP to be my own patient responsibility, my secondary insurance will still come in to help with paying 70%*3000=$2100, and the amount my secondary insurance paid does not go back to be reported to the primary insurance, so that Cigna still count me as meeting my MOOP for the year. Is this correct? In effect, the actual amount I will pay out-of-own pocket will be $900 in this ($3000 MOOP allocated by my primary – $2100 by my secondary), while my $3000 MOOP is met? Thank you! submitted by /u/firstandlastbar [link] [comments]Read Morer/HealthInsurance