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Member Covered by Spouse's Plan

Situations in which people are covered by multiple plans most commonly arise when two partners both receive healthcare benefits through their jobs. These benefits are typically expanded to spouses and domestic partners; so as a result, each partner is covered by two health plans. If health care benefits are coordinated, the insurance companies share the burden without overpaying, and the insured is fully covered, but not covered to excess.

 

Dependent Covered by both Parent's Plans

If both parents have health benefits, under the birthday rule, the insurance company associated with the parent with a birthday earlier in the year would be the primary provider for the children. If Bob is born in January and Sue is born in March, Bob's insurance would be the primary provider for their children.

Workers' Compensation

Members who are injured or become ill as a result of work-related accidents or environment are eligible for benefits under the Workers’ Compensation Law. Tethys ensures all accident related claims are covered by workers' compensation plans prior to disbursing funds.

 

Medicare Coverage

Medicare provides coverage for more than just the retiree population. Medicare coverage also extends to the disabled, ESRD and early retirees populations.  Tethys checks for the existence of Medicare coverage for members in these populations before disbursing funds and follows Medicare's Secondary Payer Guidelines.

 

Dependent Coverage When Parents Are Divorced

A divorce decree can place one health plan as primary over the other health plan. If a decree is not issued then the custodial parent's health plan is the primary plan.