Understanding Dual Coverage Dental Insurance & Coordination of Benefits

What happens if you or a family member has more than one dental plan? If both plans cover two cleanings a year, do you now get four cleanings?

Not exactly.

You don’t get double the benefits if you are covered by more than one dental plan, nor do you get reimbursed twice for your dental exam. However, you may save money on dental treatment. Read on to learn more about dual coverage dental insurance.

How Dual Coverage Works

When you are covered by two dental plans, this is called dual coverage. Coordination of benefits (COB) is the guide insurance companies, like Delta Dental of Arizona, follow to determine how much each dental plan will pay. When dental insurers coordinate benefits, their goal is to make sure that the combined benefits from all of your dental plans do not exceed 100% of the dentist’s charges.

Here’s an overview of how coordination of benefits works:

1. The primary plan pays the claim per your benefit coverage.
2. The secondary plan reviews the claim and the primary plan’s payment. It pays any unpaid balance for covered services, but will not pay anything toward the primary plan’s deductible (if there is one).

It’s fairly easy for adults to figure out which plan is primary or secondary: Typically, the plan you get from your job is the primary plan and the plan coverage you get from a spouse or domestic partner is secondary. For children, the primary insurance is usually determined by the coverage of the parent whose birthday (month and date) is earlier in the year. The year does not matter. For example, if the father’s birth date is 11/17/75 and the mother’s birth date is 4/8/74, the mother’s coverage is primary. These rules may differ if parents are divorced.  It’s also important to keep in mind that plans may have different rules for coordinating benefits, so it is always a good idea to check your benefit booklets for details.

Advantages of Dual Coverage Dental Insurance

The main advantage of dual coverage is that it may save you money on dental care. If the primary plan doesn’t cover a certain treatment or covers it only partially, the secondary plan could cover some or all of the remaining balance (assuming the treatment is also covered under the secondary plan).

Here’s an example of coordinating benefits with dual dental coverage:

• You go to the dentist for a filling. The dentist charges $100 for that service and submits the claim to both insurance companies.
• Your primary plan covers fillings at 90% and issues a check to the dentist for $90.
• Typically, you’d receive a bill for $10, but you have dual coverage. Your secondary plan covers fillings at 80% of the cost.
• The secondary plan issues a check for $8 of the $10 balance to the dentist.
• You receive a bill for the remaining $2, plus any applicable deductibles.

Disadvantages of Dual Coverage Dental Insurance

There are a few potential downsides to dual dental coverage:

• If you’re covered by two or more dental plans, you may be paying for redundant coverage.
• If your dental plan has a non-duplication of benefits clause, the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows.
• If you don’t let your dental office know that you have dual coverage, they may not submit your dental claim correctly. Knowing which plan is primary or secondary ensures that claims are processed correctly and quickly. If a claim is processed in the wrong order, the claim could be delayed or reversed and adjusted. When this happens, you might be on the hook for any remaining balance.

Questions?

Delta Dental of Arizona’s customer service team is happy to assist you with any questions you have about dual coverage. Log in to the member portal to view your plan details or contact us with a specific question about dual coverage dental insurance.  If you’re interested in buying an individual/family dental plan, visit smilpoweraz.com.