What is dual dental coverage?
If you are covered under two different dental insurance plans, then you have dual dental coverage. Dual coverage usually happens when you have two jobs that each provide dental benefits, or you are covered by your spouse’s dental plan in addition to your own.
Having dual coverage doesn’t double your benefits, but you might pay less for dental procedures than if you were covered under just one plan because treatment costs may be shared between your two carriers up to 100%. All dental plans will have contractual language to determine how coordination of benefits (COB) will be handled between the two plans and how it could impact your out-of-pocket costs.
How does dual coverage work?
One dental plan will be designated as the primary plan and the other as the secondary. In most cases, the secondary policy will not accept a claim until after the primary policy has paid for services according to the available benefits under that policy. Then, the secondary policy will ask for a copy of the payment information, also known as the explanation of benefits or EOB from the primary insurer.
With dual coverage, your two carriers will make sure that the combined amount paid by the two plans does not exceed the total dentist charges.
Will I receive twice the benefits?
As nice as it might sound, dual coverage does not mean you will receive twice the benefits. Depending on your benefit plan you may:
- receive benefits up to the full amount you paid for the procedure
- experience a lesser co-pay than if you only had one plan
- receive no additional benefit from your secondary plan
How do I know which is my primary carrier?
The primary carrier is the one for which you are covered as the member (for example – dental insurance provided by your employer rather than your spouse’s). If you have two jobs, than your primary carrier is the dental plan that has provided coverage for longer.
When does the secondary plan pay?
Usually, the secondary carrier will not accept a claim until the primary claim has been paid. At this point the secondary policy will require a copy of the primary EOB to coordinate benefits.
Specific COB limitations will depend on your dental plans, insurance providers, state law and other factors. If you have two dental insurance policies, be sure to talk to both insurance carriers to fully understand if and how dual coverage could benefit you. If the combined level of insurance is important to you, then make sure you understand COB for your dental plans prior to making any major dental treatment decisions.Leave a reply →