Spousal health coverage when you have your own coverage

[killramos]

Hey i was wondering if anyone has any experience with this, something i know about nothing about. Ultimately i know i need to ask my providers for confirmation but i want to know if its even worth pursuing.

So I have health benefits through work. This extends to my wife as spousal coverage.

My Wife also has benefits now, and her benefits should also extend to me through spousal coverage.

I need new glasses.

I know i need to use my own coverage as the primary, but I am over my maximum covered amount for vision care ( eye exam and glasses as coverage has a 24 month max that I cant use again until sept) on my personal coverage.

So generally speaking should I be able to claim an eye exam and new glasses on my wife's plan?

New territory for me as her coverage is new and I have never gone over my coverage amount for anything before let alone having two overlapping health insurance plans.

Much appreciated. :thumbsup:

[msommers]

Call her insurance provider for exact answer?

[vengie]

Originally posted by msommers
Call her insurance provider for exact answer?

/ Thread.

[roopi]

Didn't you mention your wife is a teacher? If so then there is no vision coverage on her plan. Just claim it under her health spending account.

[Strider]

Originally posted by killramos So generally speaking should I be able to claim an eye exam and new glasses on my wife's plan?
Yes.

Some providers will make you submit a claim to your own insurance first in order to show how much was covered (or that it was rejected). Call her provider (or read through her paperwork under coordination of benefits) for full details.

[killramos]

Originally posted by roopi
Didn't you mention your wife is a teacher? If so then there is no vision coverage on her plan. Just claim it under her health spending account.

Yup she is, i'll look into that. I know about 0 about her coverage as i have never needed it before.


Originally posted by Strider

Yes.

Some providers will make you submit a claim to your own insurance first in order to show how much was covered (or that it was rejected). Call her provider (or read through her paperwork under coordination of benefits) for full details.

Sounds easy enough, my claims process is automatic so it will just spit out my 0$ refund from the website.

[nzwasp]

Originally posted by Strider

Yes.

Some providers will make you submit a claim to your own insurance first in order to show how much was covered (or that it was rejected). Call her provider (or read through her paperwork under coordination of benefits) for full details.

This is how I've always done it as well because my benefits roll over time for glasses was always 6 months out from my wifes. So I would claim my eye glasses under mine and then in summer prescription sunglasses on the wifes plan.

[jwslam]

I thought some thing came into play about birthdates... that's how it worked for my parents.

i.e. Dad is older than mom, but mom's bday is Sept and dad is Oct so it goes to claim through mom's first.

Yes I know, it makes no sense, but that's how they got their claims processed for at least 4 pairs of glasses IIRC

[RealJimmyJames]

When I've done coordination of benefits, the plans have always required a statement from the primary insurer (yours) even if there is no coverage. They want to see that claim get denied before they will consider it under the second plan.

I've heard about that birth date thing for kids, but never for adults who both have coverage.

Exact terms and conditions could vary, as mentioned, call your insurance provider for their preferred method.

[Kloubek]

Yes, as mentioned.

I really like having two medical plans. Especially for any drugs, I generally don't have to pay a dime.