WP: Gov. Kaine: state employee health plan to cover same-sex partners

[SnyderShrugged]

And two premiums are paid.

And the premiums are more than the payments. (That's how the insurance company makes money.)

No, that isnt correct. Premiums are dramatically lower than claims payments. Insurers "spread the risk" over multiple premiums, invest them and then pay future claims with the money earned from the investments.

[SnyderShrugged]

hey, I gotta run for the evening guys, but enjoying the conversation! TTYL

[PrettyInPink_SkinsGear]

I think there's a misunderstanding about the nature of primary vs. secondary insurance in this thread. Be back later to explain in detail, kind of short on time at the moment. But to the guy who has dental coverage for himself and through his girlfriend, that's probably fine.

In a paragraph or less:

You will have to declare to each carrier that you have more than one insurance policy (you probably already did this if you checked the box that said "do you have other insurance?" when you signed up), one will be designated as the primary, and one will be designated the secondary. You may or may not be allowed to select which one you want to carry as your primary. Your dentist will submit a claim to both the primary and the secondary, the primary will pay their maximum allowable, and then anything left over will get billed to the secondary. Most secondaries have a set percentage that they will pay as the secondary, which will probably cover any remaining balance but may not.

[SnyderShrugged]

I think there's a misunderstanding about the nature of primary vs. secondary insurance in this thread. Be back later to explain, no time at the moment. But to the guy who has dental coverage for himself and through his girlfriend, that's probably fine.

In a paragraph or less:

You will have to declare to each carrier that you have more than one insurance policy (you probably already did this if you checked the box that said "do you have other insurance?" when you signed up), one will be designated as the primary, and one will be designated the secondary. Your dentist will submit a claim to both the primary and the secondary, the primary will pay their maximum allowable, and then anything left over will get billed to the secondary. Most secondaries have a set percentage that they will pay as the secondary, which will probably cover any remaining balance but may not.

Glad I saw this!

Good stuff and correct! (LJS is a wonderful woman though;)

[twa]

because two claims are paid for one procedure.

Ya'll supposedly set rates by risk and pay for the same procedure(separate patients) all the time...how does the risk change?

You telling me a person with double coverage (and premiums) is a higher risk somehow?

I can understand employers and govt funded premiums being a issue if they have other coverage from a financial burden side,but not from the ins co side.

The IRS certainly has a interest in gains and could count it as income,but it seems the ins is gaming the system(as usual;)) to my ignorant eyes.

added

PrettyInPink...I'm familiar with that,but why is it wrong to expect full payment for claims on each policy if you are paying two full premiums?

What is the difference in that and having two life ins policies?...which is allowed.

[Larry]

No, that isnt correct. Premiums are dramatically lower than claims payments. Insurers "spread the risk" over multiple premiums, invest them and then pay future claims with the money earned from the investments.

OK, so make that "The premiums, and the returns on them, are bigger than the claims."

If I'm making a profit on a policy, then when I double the premiums, and double the claims, then I've . . . doubled the profit.

[Larry]

A different way of looking at it:

Bill has insurance. He makes payments, and the insurance company pays claims. The insurance company makes a profit out of the deal.

Bob has identical insurance. He makes identical payments, and the insurance company pays identical claims. The insurance company makes an identical profit out of the deal.

The reason why it hurts the insurance company if Bill and Bob are the same person is . . .

[twa]

OK, so make that "The premiums, and the returns on them, are bigger than the claims."

If I'm making a profit on a policy, then when I double the premiums, and double the claims, then I've . . . doubled the profit.

But if ya can collect two premiums and pay half the clients you increase profits even more.

Is it statistically a different risk,in effect doubling the risk ?(or more)

I'm curious...is it illegal to collect premiums for two policies on one person?

Or just a crime to collect from the ins?:evilg:

Insurance is a odd business:silly:

http://www.huffingtonpost.com/2009/12/04/aetna-forcing-600000-plus_n_380130.

[Larry]

Now, in keeping with the Tailgate tradition of Larry arguing both sides of a debate, I have thought of a conceivable manner in which this (a person carrying two policies) might be a problem for an insurer.

Basically, it's the argument that having two policies alters the individual's behavior, causing him to act differently from the average insured which the policy was targeted on.

To invent a deliberately extreme hypothetical:

Suppose that policy AE-35 (movie reference) covers 50% of all dental expenses.

The company knows that the mere fact that the customer is going to have to cough up half of any bill, will cause the customer to limit the amount of dental work he gets done. They know that Average Customer will only file X amount of claims, if Average Customer has to match the payments.

Billy Bob buys two AE-35 policies.

Now Billy Bob has 100% dental coverage. It's certainly conceivable that Billy Bob might well decide to have a lot more dental work than the average AE-35 customer has done.

The insurance company is receiving double the premiums. but because the second policy causes the customer to alter his behavior, they're now paying out more than twice the claims.

Problem I see with this hypothetical coming true in reality is that I had to assume that the policy had no upper limit. (Or an upper limit that's so high that the insurance company is banking on very few customers hitting it.) And I can only see it applying to elective procedures.

People who are "double-dipping" on health insurance aren't going to go get hospitalized more often just because they have two insurance policies. In theory, the policies only pay for things that are medically necessary, and whether something is necessary doesn't change depending on how many policies you have.

[twa]

Just realized we are getting off topic...to correct that

Queers suck

and have fun doing so:silly:

[stevenaa]

Bear in mind, it's defrauding the insurance company and even their employers.

Yes, two premiums are collected. But the employers are subsidizing those premiums. Also, one of the two insurance companies is paying a claim that is already paid by another company for the same procedure.

End result, higher premiums for everyone.[/Quote]

Not correct in all cases. If my wife worked and had insurance, I would have to declare this to my employer. Her insurance company would be first carrier for her and mine would pick up the costs her insurance company didn't cover.

[Stadium-Armory]

Well done TWA

[Hubbs]

Don't necessarily object to the plan. (Since, supposedly, the partner will be paying 100% of the cost.)

OTOH, the whole thing of having the Governor do this by Executive Order, after he loses the election, just seems so . . . George Bush.

Tim Kaine has lost an election?

[techboy]

OTOH, the whole thing of having the Governor do this by Executive Order, after he loses the election, just seems so . . . George Bush.

Virginia governors are not allowed to serve consecutive terms, so he was going to have to leave office anyway. He didn't lose.

[81artmonk]

I don't have an real issue with this as long as there are rules. However, the problem I do have with it, is what if long time live in boy/girl friends want coverage. Basically the same thing.

My rule comment was, that there would have to be a time frame of commitment between the two prior to being able to get coverage. Like 5 or more years together.

[SnyderShrugged]

Not correct in all cases. If my wife worked and had insurance, I would have to declare this to my employer. Her insurance company would be first carrier for her and mine would pick up the costs her insurance company didn't cover.

right, I was strictly speaking of treating both policies as primary and claims submitted in full to both. There definitely isnt an issue with one covering the gap between the two.

[SnyderShrugged]

Now, in keeping with the Tailgate tradition of Larry arguing both sides of a debate, I have thought of a conceivable manner in which this (a person carrying two policies) might be a problem for an insurer.

Basically, it's the argument that having two policies alters the individual's behavior, causing him to act differently from the average insured which the policy was targeted on.

To invent a deliberately extreme hypothetical:

Suppose that policy AE-35 (movie reference) covers 50% of all dental expenses.

The company knows that the mere fact that the customer is going to have to cough up half of any bill, will cause the customer to limit the amount of dental work he gets done. They know that Average Customer will only file X amount of claims, if Average Customer has to match the payments.

Billy Bob buys two AE-35 policies.

Now Billy Bob has 100% dental coverage. It's certainly conceivable that Billy Bob might well decide to have a lot more dental work than the average AE-35 customer has done.

The insurance company is receiving double the premiums. but because the second policy causes the customer to alter his behavior, they're now paying out more than twice the claims.

Problem I see with this hypothetical coming true in reality is that I had to assume that the policy had no upper limit. (Or an upper limit that's so high that the insurance company is banking on very few customers hitting it.) And I can only see it applying to elective procedures.

People who are "double-dipping" on health insurance aren't going to go get hospitalized more often just because they have two insurance policies. In theory, the policies only pay for things that are medically necessary, and whether something is necessary doesn't change depending on how many policies you have.

dont forget the potential for extremely large claims in the case of a catastrophic event. Those are where the risk is extended well beyond the normal health care events.

[twa]

dont forget the potential for extremely large claims in the case of a catastrophic event. Those are where the risk is extended well beyond the normal health care events.

Why?

Sure the argument works once a claim occurs,but that is the reason for pre-existing exclusions and paying premiums in advance.

Why is the risk more than doubled.(as the premiums are)

[Larry]

dont forget the potential for extremely large claims in the case of a catastrophic event. Those are where the risk is extended well beyond the normal health care events.

Nope. In that case, the numbers still say that the insurance company will double their profit.

The odds of Joe having a major claim are exactly the same, no matter how many policies he has.

If he has two policies, then the insurance company has twice the money coming in, twice the money going out, and identical odds. Their expected gain is double.

[ljs]

Glad I saw this!

Good stuff and correct! (LJS is a wonderful woman though;)

Hey thanks! I just saw this btw...been a busy weekend.

right, I was strictly speaking of treating both policies as primary and claims submitted in full to both. There definitely isnt an issue with one covering the gap between the two.

So to add, I have a $1000 limit on the dental work that can be done in a year, not sure if gf's is same. Would it work if I were to use her extra coverage to pay anything over that amount?

Either way, calling the company is on my to-do list this week.