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Covered by primary and secondary insurance
Feb 18, 1999

The HIV-positive person in question is covered by his own policy and secondarily covered by his wife's policy, which is a family policy. He has chosen to use his wife's policy to pay for his prescription drugs because the co-pay is lower. He therefore uses his own insurance company as the secondary payer on prescription drugs. Can his wife's insurer withdraw coverage if they discover this? His own insurance company encouraged him to use his wife's policy in this way. But, I'm not totally trusting their motives. Thank you.

Response from Ms. Franzoi

If his wife's plan has a traditional coordination of benefits clause, I am surprised that the plan is paying when they know he has other coverage which is primary. Typically, the plan which covers the person as an employee is primary and pays first. Any other coverage is secondary. If a secondary plan pays in error or doesn't have the correct information which would make them aware of the fact that they should be secondary instead of primary, the plan would have the right to request a refund of all benefits paid. You need to check the coordination of benefits provision carefully and abide by it. Failure to do so could result in you having to reimburse the plan.

Lynn Franzoi



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