The Ins and Outs of COB Approach: Is It Legal to Have Dual Health Insurance?

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Date: Mar 09, 2021. Author: Victoria Berezhetska

Using the current insurance coverage to the best advantage is what any individual anticipates. But what if it was possible to double the value?

Today, working people with no active health insurance are rarely encountered. It explains why employer-provided coverage is one of the notorious insurance types nationwide. For instance, 55.4% of policyholders had this type of coverage in 2019. And at the same time, private health insurance remains the most prevalent form of protection in the United States. Why is that the case? 

It can be attributed to the possibility of accessing several health insurance plans. This way, Americans can effortlessly enhance their coverage and significantly cut their costs via coordination of benefits, also known as COB. 

So, here is the essential information on using several policies and the intricacies of the COB model.

Understanding How COB Works

The first thing you need to know about COB is that it determines the coverage hierarchy. With two active insurance plans, a person has the right to receive twice as many benefits, file twice as many claims, and receive payments predicated on the COB. But keep in mind that it does not imply double-dipping. 

COB determines the principal and secondary insurance, each paying its fair share. The following example will illustrate how COB works in a nutshell.

Let’s imagine that you book an appointment with a doctor, and he bills you $250. The principal insurance will kick in first and cover only its portion, which is presumably $120. The tangential insurance will pay the substantial part of the remaining balance if these specific health services are included in it. So, let’s say that it covers $80, which means that you will only have to pay the remaining $50.

Yes, it does sound appealing. But keep in mind that two active plans also double your premiums and deductibles. Consequently, dual coverage is not always a top choice for applicants. Let’s find out how and when you can profit from having access to two policies.

Common Scenarios of Utilizing Two Plans

The scenarios are more common than one could imagine, and here is why:

1. Looking for suitable health coverage is a typical approach for family members. If both spouses are covered by their employers and have personal insurance, they can include each other in their policies. This way, it is possible for them to get payments from both policies in accordance with COB.

2. Young adults (not older than 26) can obtain coverage through their jobs and be included in their parents’ policies, which also qualifies as dual insurance. 

3.  Kids can be indicated as dependents on their parents’ personal plans, enabling them to obtain twice as much coverage. 

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How Does Secondary Insurance Work With Deductibles?

As noted earlier, all the insurance payments double if you choose to have more than one active plan. Besides, you cannot use the tangential insurance to pay the deductibles required by the principal one. That is why it is crucial to weigh all the pros and cons before getting several policies and increasing your costs.

Let’s use an example to illustrate the interdependence of policies. If you purchased an EPO plan, your principal policy falls under specific rules. And the rules imply that you can only gain access to a limited list of local doctors and hospitals. So, let’s assume that you chose to visit an out-of-network specialist. In this case, none of the active policies will cover the costs.

What is the reason? Non-compliance with the rules of your principal policy requires you to pay the whole sum out of pocket. It might be only an example, but you need to keep in mind that obtaining numerous policies requires additional attention and greater expenses.

The Perks and Downsides of Using More Than One Health Insurance

There are several clear advantages to being on your spouse’s or parent’s plan. This way, your significant other or your mom can have your back if you get laid off or decide to quit. It is no secret that staying uninsured for too long can be a big gamble. And if your coverage depends on your job, being on some else’s plan is a great contingency plan. 

And while combining several policies can cost an arm and a leg, there is a strong possibility that you will enjoy its beneficial impact, substantially enhancing your ongoing coverage. 

Naturally, it is all about your state of health and future requirements. If you are not completely sure that one policy is enough, calculate the total costs and compare them against the extra coverage. In case the latter prevails, proceed without hesitation.

Victoria Berezhetska

The content writer that covers insurance industries.

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