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Home » Business And Finance Articles » Health Insurance Rules

Health Insurance Rules

Many dual income couples, include their children on each group health insurance plan to maximize benfits. However, without some sort of system in place to help the health insurance companies coordinate benefits, it's possible that either you or your doctor would be reimbursed for more than 100 percent of the actual cost of your claim.

To prevent this, health insurance companies typically designate one parent's health insurance plan as the primary plan and the other as the secondary plan. (That's why the patient questionnaire at your doctor's office asks for information on primary and secondary coverage.) The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in.

THE DATE OF BIRTH DETERMINES WHICH HEALTH INSURANCE PROVIDES COVERAGE

The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor not the year so it doesn't matter which spouse is older.

Like most rules, the birthday rule has exceptions:

- If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.

- If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer, the plan belonging to the curently employed spouse would be primary.

- In the event of divorce or seperation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new new spouse's coverage becomes secondary. And finally, the non custodial parent's health insurance plan would provide a third layer of insurance protection. This order of payment can be altered by a court issued divorce decree or by agreement, but the health insurance companies must be notified.

THESE ARE JUST HEALTH INSURANCE RULES NOT THE LAW

Keep in mind that these practices are common among health insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy coverage is unclear, ask for help from your employers benefit specialist or your insurer's customer service department.

And here is another random article you might be interested in...

Can You Hear Me Now?

When you listen to a customer (or co-worker, spouse, significant other), your brain is constantly making hundreds of assumptions. Each word, inflection, and tone of voice is interpreted, but not always as the speaker intended. Research shows that 2/3rd of all employees feel management isn't listening.*

We all think we know how to listen, yes? The fact is that very few people know how to truly listen. In our earnestness to serve, we get pulled out of a conversation by preparing for the answer while the other person is still talking. We wait for a pause and when the person takes a breath, we jump in to improve or remedy the situation.

Or, we worry about the question that we may be asked that we might not be able to answer intelligently. Will we know the answer? Will we be able to respond appropriately? What if I am asked a question I don't know the answer to? What if I don't understand the question? What if they find out that I'm new on the job/on the equipment/at this company? What if they get angry at me? What if I frustrate them? What if, what if, you fill in the blank. We are anywhere but listening to the other person.

Our intentions are good. We want to give the best response we can, hopefully the right answer. However, if we are not present to the conversation, the other person feels not heard, unimportant, ripped off, and the like. If there was no upset on their side to begin with, it now exists big time. Fact: if you are not listening to the customer, there is no way you can answer the question. The truth is you probably haven't even heard it.

Listening is our least used and weakest communication skill. None the less, great customer service professionals are first and foremost great listeners. Active listening forces us to tune in to what the customer is saying, instead of trying to think of what our responses will be.

Hearing and listening are not the same, though many people use the words interchangeably.

Hearing is a physiological process whereby auditory impressions are received by your ears and transmitted to your brain.

Listening involves interpreting and understanding the significance of the sensory experience.

The derivative of listen is 'list,' which means to lean toward one side. Have you ever noticed how you lean in when someone is talking to you, or vice versa? Even on the phone?

When you listen, you win and the other person wins. But it is not enough to just listen, you have to communicate to people that you're listening. Sometimes people don't think you're listening when you are because you're not communicating that you're listening.