If you are covered by two dental plans…
When you are covered by two dental plans this is called “dual coverage.” This does not “double” your coverage. However, it may reduce your out-of-pocket costs.
Dual coverage works the same way whether you are covered by two dental insurance plans of the same company or by two different dental insurance companies. Your primary dental insurance simply works with the other insurance company (secondary insurance) to coordinate your benefits.
Which plan pays first?
The plans set forth rules to determine which plan pays first, (“primary”) and which plan pays afterwards (“secondary”). The general rule is that the plan that covers you as an enrollee is the primary plan and the plan which covers you as a dependent is the secondary plan.
For your children’s coverage, generally the primary insurance company is determined by the birthday rule (i.e., coverage of the parent whose birthday —month and day, not year — comes first in the year is considered to be your children’s primary coverage). A divorce agreement or other court ruling may supersede the birthday rule.
How dual coverage works
For example, if both of your plans provide two cleanings a year, each with 80 percent coverage, then: You would not be entitled to four cleanings a year. The primary plan pays its benefit as if there is no other insurance The secondary plan will act as a supplement to the primary plan with its payments limited to the lesser of its normal benefit or the patient’s out-of-pocket costs under the primary plan.
Non-duplication of benefits clause
Some dental benefit plans have “non-duplication of benefits” provisions. This means that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist.
For example, if both the primary and secondary carrier pay for the service at 80 percent level but the primary allows $100 and the secondary carrier normally allows $80 for the same treatment, the secondary carrier would not make any additional payment. However, if the primary carrier only pays 50 percent of the dentist’s allowed fee, then the secondary carrier would reduce its payment by the amount paid by the primary plan and pay the difference. In this case, the secondary carrier would pay $14 ($80 x 80 percent – $50 = $14).
However, if the primary insurance plans annual maximum has exhausted all its benefits for the current policy year then the secondary insurance is obligated to pay at the rates outlined by the policy provisions of the secondary insurance plan.
Keep in mind that an insurance company will never guarantee that they will pay anything, even pre-authorizations are only determinations of benefits, no guarantee of payment.
Dual coverage saves money for you and your insurance by sharing the total cost of dental benefits between two carriers. Containing costs is an important part of your dental insurance(s) plan to keep you smiling.
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This article was written by Kathy Taylor of Legacy dental. Kathy is part of our amazing team at Legacy dental, here in Salt Lake City. Kathy is an expert in dental benefits and coordinating care to fit each patients situation.
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