Working couples can maximize their companies' health benefits


November 17, 1991|By JANE BRYANT QUINN | JANE BRYANT QUINN,1991, Washington Post Writers Group

New York -- When two-paycheck couples each have health insurance from different employers, they're often way ahead of the game. They may be able to play those policies like pianos, getting higher total benefits than one-income couples can.

Corporations are gradually closing these loopholes, but they may not yet have gotten around to you.

The working couples' advantage springs from the fact that they usually have a choice: They can use their own health plans or sign up as dependents on their spouse's plan -- sometimes getting coverage from both. Here's how to make the most of it:

(1) If both spouses have fixed-benefit employee plans and you have no children: You each may pay little or nothing for your own company's coverage. So take it, rather than becoming a dependent on your spouse's plan.

Consider your spouse's plan only if the premium is reasonable, its benefits are greatly superior, and you're in poor health. (But be sure you can get back into your own plan, without penalty or waiting period, if you get divorced or your spouse loses coverage.)

(2) If you have a flexible benefit plan that lets you substitute other goodies for health insurance: Opt out of your own company's health coverage and join your spouse's plan, if it's a good one.

Then you can use your own employee-benefit plan for some extras, like a cash payout in lieu of medical insurance, more vacation time or better child care.

(3) If you have children: Family benefits will most likely cost you 10 to 40 percent of the premium. There are two roads to take, for working couples with dual plans:

* Buy family coverage only on the better plan, after comparing them point by point.

Be sure to look at the size of the deductible, the percentage of cost you're expected to pay, exactly what's covered and what's excluded, the limits on mental health coverage and substance abuse, your maximum annual out-of-pocket cost, and the lifetime maximum the plan will pay.

Most companies levy a flat charge for all dependents -- so once your children are covered, your spouse would be, too. That gives your working spouse dual coverage (his or her plan plus yours).

A growing number of employers, however, "tier" their plans -- charging more as you cover more dependents.

Or they hit you with a surcharge if you insure a working spouse who has access to a different employee plan.

In these cases, it generally pays to add only the children to your policy, if it's the better one.

Your spouse would stick with the plan provided by his or her own company.

* Consider buying full family coverage on one or both plans if the premium is low and if your company practices "coordination of benefits." In a survey by Hewitt Associates of 1,000 major companies, 56 percent still coordinate, reports Hewitt's Tom Beauregard.

Under this system, you might get 100 percent of your medical bills covered. Here's how:

Say the husband falls ill and files a claim with his employee plan. The company pays the bill, minus certain deductibles.

The wife then submits the unpaid portions to her own company plan, where her husband is listed as a dependent.

Even if her company normally pays only 80 percent of the doctor bills, it may pay 100 percent of the remaining bill not covered by her husband's company.

Similar rules hold for children.

In general, their bills are first submitted to the plan of the spouse whose birthday falls earlier in the year. The other plan may pick up what's left.

This double coverage is slowly being eliminated, Beauregard says. Many companies are moving toward a system known as "non-duplicationof benefits," which lets you collect only the maximum each plan allows.

For example, if your plan pays 80 percent of the medical bills and your spouse's plan pays 90 percent, you could collect only the extra 10 percent.

Under this rule, it's not worth buying dual coverage for dependents.

In all cases, before opting out of your own plan, find out what happens if you need to get back in.

Will you and your dependents (including spouse as well as the children) be picked up immediately? Or will you need proof of insurability, or a waiting period for the illnesses that family members already had?

If it's hard to re-enter the policy, you might not want to leave in the first place.

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