what is dual dental coverage?
If you are covered by two different dental insurance plans, then you have dual dental coverage. Dual dental coverage typically occurs when you have two jobs that provide dental benefits, or you’re covered by your spouse’s dental plan in addition to your own.
Having dual coverage doesn’t double your benefits, but you may pay less for dental procedures than if you were covered by a single plan, since treatment costs can be shared between your two insurers up to 100%. All dental plans will have contractual language to determine how coordination of benefits (COB) between the two plans will be handled and how it might affect your out-of-pocket costs. Because state laws and regulations play a large role in determining how coordination of insurance benefits occurs, there may be variations in how they work in your state, so it’s best to check with your insurers to find out. find out exactly how cob works for you.
Some cob provisions limit what a plan will cover, while others may involve a detailed process to follow. COB provisions may also depend on individual state laws and regulations and other variables that vary by state.
In this article, we’ll explain how double coverage works, along with some related terminology and limitations to be aware of.
How does dual and cob dental coverage work?
when cob is applied, one dental plan is designated as primary and the other as secondary. In most cases, the secondary policy will not accept a claim until the primary policy has paid for services in accordance with the benefits available to the enrollee under that policy. then the secondary policy will request a copy of the payment information (called an explanation of benefits or eob) from the primary insurer.
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With dual coverage, your two insurers will make sure that the combined amount paid by the two plans does not exceed the total amount the dentist has agreed to accept from the primary insurer. this is known as the total allowable charge. In other words, the benefits of the two companies combined do not exceed the dentist’s total charges and benefits are not duplicated.
Will I receive double benefits?
As nice as it sounds, double coverage doesn’t mean you’ll receive double the benefits. Depending on your benefit plan and state law, you can:
- receive benefits up to the full amount you paid for the procedure
- experience a lower copay than if you only had one plan
- or not receive any additional benefits from your secondary plan. Dual coverage limitations are built into your dental plan and the rates your group pays for your coverage.
Here’s an example of how these limitations might work:
Let’s say you have dual coverage and each of your plans covers two cleanings per year, each at 75% coverage. As a result of dual coverage limitations, you can only claim two cleanings per year; however, your primary provider would pay 75% of the cost of each cleaning (your maximum plan allowance). Depending on the language in the secondary carriers’ contract and state law, after receiving the EOB from your primary carrier, your secondary carrier may cover up to the remaining 25% that you otherwise would have paid out of pocket (traditional COB language). It could also be a smaller amount, leaving you with a smaller copay than if you had a single policy (benefit maintenance language). Or, the secondary insurer may not pay the remaining 25% because the primary insurer has already met its responsibility to pay the 75% (non-duplication of benefits language). check your dental plan contract to determine how that would work for you.
How do I know who my main carrier is?
The primary insurer is the one for which you are covered as a member (ie, dental insurance provided by your employer instead of your spouse). if you have two jobs, then the primary insurer is the dental plan that has provided coverage the longest.
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When does the secondary policy pay? Usually, the secondary insurer will not accept a claim until after the primary claim has been paid. At this point, the secondary policy will often require a copy of the primary or EOB payment information. state laws and regulations often require cob in this situation.
Specific COB limitations will depend on your dental plans, insurance providers, state laws, and other factors. If you have two dental insurance policies, be sure to talk to both insurance companies to fully understand if and how dual coverage could benefit you. Ask what your COB provisions are and what level of benefit you are entitled to. You can also check with your company’s human resources department. If the combined level of insurance is important to you, then make sure you understand COB for your dental plans before making any important decisions about dental treatment.
1 day. “ADA Guide on Coordination of Benefits”. American Dental Association, 2020, https://www.ada.org/~/media/ada/member%20center/files/dbcq_dbiscoordinationofbenefits_2015mar10.pdf?utm_medium=vanityurl.
2 ada center for professional success. “Dental Plans – Coordination of Benefits”. coordination of benefits | american dental association | Center for Career Success, 2020, https://success.ada.org/en/dental-benefits/dental-plans-coordination-of-benefits.
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