| Families with TWO Insurance Policies Recently, this office has become aware of a loophole in Michigan's insurance regulation. This gimmick allows insurance carriers to not pay for coverage when families have dual insurance through two different employers. This loophole's name is listed as "non-duplication of benefits" clause. This clause allows the secondary insurance carrier to not pay its percentage of the treatment if the first (primary) carrier has already paid for the treatment. As an example, if treatment performed was $100.00 and paid at 50% by the primary carrier, the remaining 50% may be denied by the secondary carrier. This is the rationale behind the "non-duplication of benefits" clause. The primary carrier paid $50.00, and the secondary carrier payment would normally be the remaining $50.00, but due to the secondary insurance allowing the same dollar amount paid by the primary insurance it becomes a "non-duplication of benefit". Please note that this clause is not fully explained to the employer upon purchase of benefits. The employer is shown that they can acquire more reasonable rates by purchasing this particular benefit package. It is not until the services are denied that this reduction in benefits is realized.
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