Marriage and health insurance

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Marriage and health insurance

You're getting married, and the things that were once considered "his" or "hers" will soon be both of yours. But what about health insurance? If you both have full health benefits, does it make sense to keep both health plans? Or should you discontinue your coverage and join your spouse's health plan?
 
It is not unusual for people to choose to keep their own health plans, even after they get married. In fact, if your family consists of just you and your spouse, then it may make more economic sense for each of you to have your own coverage than for one of you to have a family plan.
 
If you are self-employed, own a small business or you don't currently have coverage from your employer, you may decide to buy an individual health insurance plan. If you do, you have several options. You can work with a health insurance agent or company, a broker, or you can buy a plan online. Online health insurance resources give you a number of options in a timely, efficient manner, some enable you to electronically check the status of your application and review your policy.
 
An option certainly worth considering is buying a health insurance policy that provides family coverage. This has a number of possible advantages: First, if you're planning on having a family soon, most family plans already have pregnancy costs built in. Second, family plans provide flexible options for both spouses and their children, such as wellness and immunization programs as part of the plan.
 
The most important aspect of all of this is for you to consider the options that most closely apply to how you're planning your life together.
 
Since you and your new spouse may be building a nest egg, you'll want to choose a plan with the services you need at a price you can afford. Fee-for-service plans offer the freedom to choose from a wide array of doctors and hospitals, but are generally more expensive than Managed Care plans, which limit your choice of doctors and coordinate your care.
 
It's wise to compare health plans from different insurance companies, since levels of coverage and prices can vary dramatically. Look for policies that cover large medical costs, and avoid policies that offer protection for only one disease.
 
It is important to understand exactly what your policy will and will not cover. And, bear in mind that most policies offer a "free look" period of 10 to 30 days after purchase, which gives you time to change your mind. Consider too, that some policies impose waiting periods before they begin paying benefits.
 
Joining Your Spouse-to-be's Plan
If your spouse-to-be has a plan that offers more of what the other needs and if the deductibles, co-pays and premiums are comparable, then it might make sense for you to join that health plan. The Health Insurance Portability and Accountability Act of 1996 (HIPPA) was established, in part, to allow equal access to healthcare benefits. Among HIPAA's many requirements is one that may allow you to add your new spouse to your plan or to add yourself to your spouse's plan.
 
Under HIPPA, group health plans and other types of agencies that provide health insurance must provide "special enrollment" periods, giving people whose personal circumstances have changed the opportunity to enroll without having to wait for the plan's next open enrollment period. If you are already covered by a health plan but become a dependent through marriage, then you are eligible to take advantage of a special enrollment period.
 
Qualifying For Special Enrollment
 
To qualify for a health plan's special enrollment period, you must notify the plan and request special enrollment within 30 days of your marriage. Some plans require written notification. If you make your request after you have been married for 30 days, then you may have to wait for the plans' annual open enrollment period. If you qualify as a special enrollee under HIPPA, then you may not be treated as a late enrollee.
 
Once you have enrolled in a plan, your coverage must take effect no later than the first day of the of the first calendar month, beginning after the date the plan has received the completed request for enrollment.
 
SOURCES: From: "Checkup on Health Insurance Choices," The Department of Health and Human Services, Agency for HealthCare Research and Quality, Washington, D.C., http://www.ahrq.gov/consumer/insuranc.htm#head1; "Life Changes Require Health Choices: Know Your Benefit Options," U.S. Department of Labor, Employee Benefits Security Administration, Washington, D.C., http://www.dol.gov/ebsa/publications/life_changes.html; Elaws, Health Benefits Advisor, "Questions and Answers: Recent Changes in Health Care Law," U.S. Department of Labor, Washington, D.C., http://www.dol.gov/ebsa/pdf/hippa.pdf
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