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Health Insurance Rules
By Ivon T. Hughes


Ppi Claims
At the time you felt pressured into taking out payment protection insurance on your loan. The representative from the bank seemed to bamboozle you with facts and figures and to be honest; you didn`t quite understand what was going on. You just wanted the loan because you needed a newer car as the engine on your old one had packed in. However, here you are a number of years later and you feel that an injustice has been carried out. A number of people have been sold PPI in the past and they have made successful claims against the bank that made them take it out in the first place. Enquire about Ppi Claims through a claim management company and you could find that you have a very strong case. You weren`t made fully aware of the facts at the time and there`s a good chance that you were mis-sold the policy. Speak to an advisor about Ppi Claims and you might even find that your policy was full of exemptions and clauses which meant it would have never been paid anyway. Highly experienced PPIs were sold to tons of people and in countless cases they didn`t guarantee to cover loan payments in times of sickness or redundancy. Plenty of people have valid reasons to make the Ppi Claims and you could be one of them.


Many dual income couples, include their children on each group health insurance plan to maximize benfits. However, without some sort of system in place to help the health insurance companies coordinate benefits, it`s possible that either you or your doctor would be reimbursed for more than 100 percent of the actual cost of your claim.

To prevent this, health insurance companies typically designate one parent`s health insurance plan as the primary plan and the other as the secondary plan. (That`s why the patient questionnaire at your doctor`s office asks for information on primary and secondary coverage.) The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in.

THE DATE OF BIRTH DETERMINES WHICH HEALTH INSURANCE PROVIDES COVERAGE

The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor not the year so it doesn`t matter which spouse is older.

Like most rules, the birthday rule has exceptions:

- If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children.

- If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer, the plan belonging to the curently employed spouse would be primary.

- In the event of divorce or seperation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new new spouse`s coverage becomes secondary. And finally, the non custodial parent`s health insurance plan would provide a third layer of insurance protection. This order of payment can be altered by a court issued divorce decree or by agreement, but the health insurance companies must be notified.

THESE ARE JUST HEALTH INSURANCE RULES NOT THE LAW

Keep in mind that these practices are common among health insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy coverage is unclear, ask for help from your employers benefit specialist or your insurer`s customer service department.

For more information about this article and/or the author visit mailto:info@trustco.ca

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