Some of our clients have received letters from their employers or health insurance providers stating that their health insurance pays for injuries on a secondary basis but is considered Qualified Health Coverage (QHC). Can that be true?

As it relates to QHC, a health plan provision that states the health plan acts as the secondary payor of medical claims related to motor vehicle accidents would not prohibit a health plan from meeting the definition of QHC for the purposes of opting out of PIP medical coverage or excluding PIP medical coverage. Furthermore, which coverage pays primary or secondary is not relevant if a consumer does not have PIP medical coverage with which to coordinate.

Coordination of no-fault benefits with a health plan is a separate consideration. DIFS expects health plans to offer two separate letters to their consumers:

  • A letter indicating whether the consumer’s coverage is QHC.
  • A letter indicating whether the consumer’s coverage would coordinate with no-fault benefits.

Please see Bulletin 2020-01-INS for more information.