Understanding Dual Dental Coverage
If you find yourself covered by two separate dental insurance plans, then you have what’s known as dual dental coverage. This typically happens when you have multiple jobs that provide dental benefits or when you’re covered by both your own dental plan and your spouse’s. Having dual coverage doesn’t mean you’ll receive double the benefits, but it can lead to lower costs for dental procedures. The two insurers may share the treatment costs up to 100%. To determine how coordination of benefits (COB) works and its impact on your out-of-pocket expenses, it’s best to check with your insurers since state laws and regulations influence the process.
- Insider Weekly: Wall Street’s Summer From Hell
- New York Insurance License Requirements – Life & Health Insurance Licenses
- How to see a doctor when you dont have health insurance | SingleCare
- Individual Dental Insurance Plans in New York | Empire Blue
- Claims Adjusters, Appraisers, Examiners, and Investigators : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics
How Dual and COB Dental Coverage Works
When COB is applied, one dental plan is designated as primary, while the other is considered secondary. In most cases, the secondary policy will only accept claims once the primary policy has paid for the services according to the available benefits. The secondary policy then requests an explanation of benefits (EOB) from the primary insurer as proof of payment. With dual coverage, it’s important to ensure that the combined amount paid by the two plans doesn’t exceed the total allowable charge agreed upon by the dentist. This means that benefits are not duplicated and that the dentist’s charges are fully covered.
Will I Receive Double Benefits?
While it may sound appealing, having double coverage doesn’t guarantee double the benefits. Depending on your benefit plan and state law, you may:
- Receive benefits up to the full amount you paid for the procedure.
- Experience a lower copay compared to having just one plan.
- Not receive any additional benefits from your secondary plan.
Dual coverage limitations are determined by your dental plan and the rates negotiated by your group for coverage. Here’s an example to illustrate how these limitations might work: Let’s assume you have dual coverage and both plans cover two cleanings per year at 75% coverage. Due to dual coverage limitations, you can only claim two cleanings per year. Your primary provider will pay 75% of the cost for each cleaning, while your secondary carrier may cover the remaining 25% depending on their contract and state law. It’s best to review your dental plan contract to determine how this would apply in your case.
Identifying Your Main Carrier
Your main carrier is the insurer through which you have coverage as a member, such as dental insurance provided by your employer rather than your spouse’s plan. If you have two jobs, the primary insurer is the one that has provided coverage for you the longest. The secondary policy usually pays after the primary claim has been settled and may require a copy of the primary insurer’s payment information, known as the explanation of benefits (EOB). State laws and regulations often mandate coordination of benefits in this situation.
Specific COB limitations will vary depending on your dental plans, insurance providers, state laws, and other factors. If you have two dental insurance policies, it’s important to talk to both insurance companies to fully understand how dual coverage may benefit you. Inquire about your COB provisions and the level of benefits you are entitled to. Don’t hesitate to reach out to your company’s human resources department for more information. If the combined level of insurance is an important factor for you, ensure that you comprehend the COB details for your dental plans before making any significant decisions regarding dental treatment.
- American Dental Association. “ADA Guide on Coordination of Benefits.” 2020. ADA Guide on Coordination of Benefits.
- ADA Center for Professional Success. “Dental Plans – Coordination of Benefits.” 2020. Dental Plans – Coordination of Benefits.