drug plan/ dental plan question from full time employee couples

[can2000]

Hi guys, my friend has a question to ask:

He recently got a full time job. Since his wife company can cover his health care insurance before, now he has to decide if he needs to decline the drug plan/ dental plan from his company? I have heard that the dental plan only covers 80% from either his wife or his company. WIll it be covered up to 100% if he uses his dental plan and his wife together? Also, how's the case of drug plan/vision plan? Thanks in advance.

[AnnaBanana]

we can't answer those questions. call the insurance providers.

[yyz2hkg]

Call your insurance providers to get a definite answer. As for both coverage, you'd have a coordination of benefits, which may mean that if his wife's plan only covers 80%, his plan would cover the remainder 20%. If he declines now, would he be able to sign up again? It all depends on the Insurance companies.

[sillysimms]

As advised you can have your friend call the insurer for a full explanation and details. yyz2hkg is right that there will be coordination of benefits.

Standard coordination of benefit rules will be used (developed by the Canadian Life & Health Insurance Association).

Combined they very likely will have 100% coverage, but will never be able to collect more than was paid out. His plan would cover up to his maximum FIRST before submitting the remainder to his wife's plan.

How it works:

Wife submits claims to her insurer first. Husband submits to his insurer first. Any amount not paid by their own insurer will then be submitted to the other's insurer with receipts/proof of what has already been paid.

Children's claims are submitted first to the plan for the parent whose birth month and day occurs earliest in the calendar year. The remainder is submitted to the other parent's plan again with proof of what was already paid to ensure that no more than 100% is paid out from the two plans combined. There are other rules for children's submissions when parents are divorced (and even rules if the parents have the same birth date!)

This works the same for dentists/drugs plan. Vision will give you a combined amount of the two (e.g. wife has $200/coverage, husband has $150 - total eligible expenses - $350 each).

ETA: This is assuming they each have the other covered on their plans. If they only have coverage for themselves the other's expenses would not be covered. For example at my company you pick single, couple or family coverage. You can only change your coverage level once a year or within 60 days of a life changing event (e.g. marriage, divorce, birth of a child, death etc.)