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A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim:

A) Both companies will share the cost of the claim
B) The husband's company will cover the claim
C) The wife's company will cover the claim
D) The husband can choose which company covers the claim

User Tonespy
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1 Answer

5 votes

Final answer:

When a husband and wife are covered by their own employer's health insurance plans, the husband's employer's insurance would cover his claim first as the primary insurance. His wife's insurance may cover remaining costs as secondary insurance, and this system helps prevent moral hazard through cost-sharing mechanisms like deductibles and copayments.

Step-by-step explanation:

The question you've asked is related to how health insurance claims are handled when both spouses are covered by their respective employer's insurance plans. Typically, there is a coordination of benefits where the insurance of the individual submitting the claim (the husband, in this case) would be considered the primary insurance and would cover the claim first. His wife's company would then be considered secondary and might cover some remaining costs, depending on the circumstances and the specifics of both insurance policies.

Insurance companies often have cost-sharing mechanisms such as deductibles, copayments, and coinsurance which require the policyholder to pay a certain amount of the cost. An employer mandate usually requires companies with more than 50 employees to provide health insurance, so both spouses should have primary coverage through their respective employers.

Considering these factors, the correct answer is B) The husband's company will cover the claim, as it is the primary insurance since the husband is filing the claim.

User AXheladini
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