health sectionhealth sectionAs more and more American families are forced to rely on multiple incomes to generate enough money to pay for living expenses, the instances of duplicate health insurance coverage continue to rise. While it may seem beneficial to be covered by more than one medical benefits plan, it's essential that you understand how health insurance carriers deal with claims in these cases. Knowing what to expect and how double coverage affects the payment of your claims will save you time and reduce potential confusion.
While most Americans understand that health insurance is important to ensuring quality and affordable healthcare, millions remain uninsured throughout America, 3 million of which live in Georgia according to a 2009 Families USA report. That represents one in every three people in the state's population that does not have access to affordable healthcare without the threat of high medical bills and possible bankruptcy. Fortunately, programs available through the Georgia State Insurance Commission and provisions in the 2010 federal health reform bill are making it easier than ever for residents to find health coverage.
According to The New York Times, health care in 2009 reached $2.5 trillion, a number that represents more than 17 percent of the U.S. economy. Because the health care industry makes up such a large portion of the economy, it is no wonder that the government regulates it, perhaps implementing the most rules for the health insurance companies themselves.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed by Congress in 1986. Laid-off employees may continue their health insurance coverage, usually for up to 18 months, under COBRA. The former employee pays up to 102 percent of the employer's costs for continued coverage.
There are no published standard practices when it comes to verifying health insurance. Different states can issue different mandates for publically run institutions, but private institutions can operate on whatever policies they develop internally. With that being said, many hospitals have adopted similar standards when choosing what to do when verifying insurance, and there are a few things required of emergency rooms in particular.
Most insurance plans and claims payors coordinate benefits between two health plans when a patient has coverage by more than one insurance plan or carrier. Coordination of benefits is a standard practice and cost may be shared between both plans. Rules determining the order of payment and which insurer is billed first are set by the National Association of Insurance Commissioners (NAIC). These rules determine the patient’s primary and secondary plans. The primary plan is billed and pays first and the secondary plan will likely cover the remainder of medical expenses.
Michigan laws on health insurance provide very specific rules and regulations on group health insurance as well as individual health policies. These laws are enacted to provide a way for you to obtain health insurance. However, while some of the laws in Michigan are designed to benefit you, some laws are in place to benefit insurance companies. Make sure that you understand what insurers can and cannot do in your state.
Group health insurance rules vary slightly from state to state, although there are basic national standards that provide some uniformity. Self-insured group health plans differ in that they are not regulated by the state. This type of group health insurance is regulated at the federal level. Self-insured is also referred to as non-insured since it is not insurance purchased through an insurance company.
Health insurance provides coverage for medical procedures and conditions as determined medically necessary by the provider. The rules that govern health insurance are complicated and may depend upon the state in which you live. Georgia has its own health insurance rules for insurance companies doing business within state lines.
The Maryland Insurance Administration (MIA) is an independent agency that is responsible for regulating the state's health insurance industry. MIA's primary functions are to familiarize consumers with Maryland's health insurance rules and to protect them by making sure that insurance companies are acting in accordance with the law. Further information can be obtained by contacting the MIA directly. Maryland Insurance Administration 200 St. Paul Place, Suite 2700 Baltimore, MD 21202 410-468-2000 mdinsurance.state.md.us
