Insurance

Question: Question about health insurance and life time maxium benefits?

(Posted by: *EmmaSurella* on 2010-07-25 08:03:37)

Let's say you have a policy with Blue Cross Blue Shield, and you have a lifetime maximum of $25k for a particular type of coverage under that plan. Let's say you max that out, then you switch to a different policy under the same insurance company (under your spouses employer). Would that lifetime max start over? Or does lifetime max go by your SSN regardless of the policy number?

Posted by: Flower on 2010-07-25, 08:15:44

Those are policy limits. You should call the plan administrator and ask if you reached your lifetime cap on one policy whether they would let you go on your spouse's policy. Sometime in the next few years, the lifetime cap on health care will be eliminated under the new law.

Posted by: StephenWeinstein on 2010-07-25, 10:55:11

It is considerably more complicated: 1. Different policies have different lifetime maxes. 2. There are actually several different companies called Blue Cross Blue Shield, probably between 50 and 100 (not counting the ones in New York State, which has separate ones for each region of the state), each of which is an independent licensee. When you switch from your employer's plan to your spouse's employer's plan, you may be switching to a new insurance company, even if they are both named Blue Cross Blue Shield.

Posted by: Insurance Pickle.com on 2010-07-25, 12:01:48

The policy itself has a maximum. IF you are able to switch to a new policy then that policy would have a new maximum. However, if it were to have a $25k maximum and you were charged $50k you wouldn't be able to switch to get that balance paid. That would be out of your pocket. The other part of the equation is that if you're hitting maximums then the likelihood that you'd be able to switch is slim.