Personal Finance

Question on spouse medical insurance coverage

  • Last Updated:
  • Aug 15th, 2021 12:34 pm
[OP]
Deal Addict
Jan 29, 2010
1876 posts
2921 upvotes
Toronto

Question on spouse medical insurance coverage

My spouse and I are both employees at companies with medical insurance with a new child. Previously, we always just covered ourselves at around 80% coverage options and didn't put the other in each other's medical insurance plan.

I have recently heard that some other couples add the spouse and child in the insurance plan (this usually doesn't cost anything extra), while the other just gets the lowest insurance option (eg. 20% coverage that yields a lot of $ in health/wellness saving account.) Then, when they claim for any medical expenses, they claim from the 80% insurance plan as well as the 20% insurance plan, totaling to full insurance coverage.

Is this how people maximize their medical coverages? We were always under the impression that you can't claim each expense twice.
7 replies
Sr. Member
Mar 7, 2008
785 posts
235 upvotes
jillaryit wrote: My spouse and I are both employees at companies with medical insurance with a new child. Previously, we always just covered ourselves at around 80% coverage options and didn't put the other in each other's medical insurance plan.

I have recently heard that some other couples add the spouse and child in the insurance plan (this usually doesn't cost anything extra), while the other just gets the lowest insurance option (eg. 20% coverage that yields a lot of $ in health/wellness saving account.) Then, when they claim for any medical expenses, they claim from the 80% insurance plan as well as the 20% insurance plan, totaling to full insurance coverage.

Is this how people maximize their medical coverages? We were always under the impression that you can't claim each expense twice.
You definitely can do this.
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Deal Fanatic
Jan 15, 2017
5234 posts
5275 upvotes
Ottawa
It's called Coordination of Benefits and some plans do allow it. Check with your plan provider and see if it is allowed and if so you would benefit.
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User avatar
Dec 11, 2003
2764 posts
1319 upvotes
Toronto
If you are not covered on each other's insurance you better ask if your child is covered. From what I remember it's either single coverage (yourself) or family coverage (with your spouse and children). Also, you better inform your insurance company that you have a child now. Even if I'm remembering incorrectly I think it would be better to ask to make sure that your child getting coverage.

If you and your wife both have family coverage and the dentist visit was $125 then it could be like this. You claim under your insurance first if your birthday is before your wife's birthday. Your insurance could say no, our data shows a visit to the dentist is only $100. We'll cover 80% of $100 which is $80. Then you can claim $45 to your wife's insurance. I don't remember if your wife's insurance would give you 80% of $45 or if they could come back and say no, our data shows a visit to the dentist is only $90. 80% of $90 is $72 but since you're only claiming $45 so we'll pay out $45. I remember there was some instances where you might not get the full amount back.
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Deal Fanatic
Mar 21, 2010
6576 posts
3733 upvotes
Toronto
jillaryit wrote: Is this how people maximize their medical coverages? We were always under the impression that you can't claim each expense twice.
Check with your insurance company, but this is pretty common. You're not claiming the same expense twice, you're claiming for different portions of the same expense (e.g., the first 80% followed by the remaining 20%).
Deal Fanatic
Jan 21, 2018
7587 posts
8183 upvotes
Vancouver
Make sure you sort this out promptly. Many corporate group plan agreements say that employees with a spouse and.or dependents must promptly disclose this to the insurer and apply for family benefits or obtain a waiver. Failure to do so may mean denial of coverage, or at the very least the employer will be back-billed any extra plan cost to the date for information should have been disclosed, even if no claims were made.
[OP]
Deal Addict
Jan 29, 2010
1876 posts
2921 upvotes
Toronto
Thanks for the replies. Another question I had: In terms of adding my spouse, she's not technically a "dependent" because she has her own job. Can we still add each other for medical insurance?
Deal Expert
Aug 22, 2011
37869 posts
23965 upvotes
Center of Universe
jillaryit wrote: Thanks for the replies. Another question I had: In terms of adding my spouse, she's not technically a "dependent" because she has her own job. Can we still add each other for medical insurance?
Yes, you'll be added as each other's spouse/partner.

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