Most Americans who have health insurance receive coverage under a single health plan. However, depending on your specific situation and health care needs, you might have access to two health insurance plans, which may provide significant financial benefits.
You might have access to coverage under two health care plans if:
How do the two plans work together?
Having coverage under two health plans doesn’t mean the two plans will pay the same amount twice for the same doctor visit. The plans will never pay the doctor—or you—more than 100 percent of the cost of a medical or dental service.
In cases where a person has dual coverage, there are rules about which plan pays what, known as “coordination of benefits.” The rules for this vary among states and insurers. But, the general idea is that one plan will function as the primary plan, and the other will serve as the secondary plan.
When a member with dual coverage files a claim, the primary plan will pay whatever it is responsible for paying under the terms of the plan. It will proceed as if the secondary plan doesn’t exist. After the primary plan pays its part, the secondary plan will pay whatever (if anything) it covers that the primary plan hasn’t already paid—up to 100 percent of the bill.
If the two plans closely overlap in the types and rates of coverage they offer, you might not see a significant benefit. On the other hand, depending on how the plans differ, you may not have to pay as much out of pocket as you otherwise would have with a single plan.
How do you know what each plan covers?
Finally, remember there is not a single best answer for everyone. However, educate yourself about your health care needs and your health care plans is the first step to finding the best solution for you and your family.
If you are looking for individual or group health insurance, contact us at (888) 535-4831 to get in touch with an agent who can help you through the process, or request a quote at https://www.sanfordhealthplan.org/get-a-quote.
Current Sanford Health Plan members can access their SBC and other plan information in their secure member portals at sanfordhealthplan.com/memberlogin or by contacting customer service at the number listed on the back of your insurance member ID card.