What is dual dental coverage?
If you are covered under two different dental insurance plans, then you have dual dental coverage. Dual dental coverage typically occurs 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%.1 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. Because state laws and regulations play a substantial role in determining how insurance benefit coordination occurs, there may be variations in how they work in your state, so it is best to check with your insurers to find out exactly how COB works for you.
Some COB provisions limit what a plan will cover, while others can 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 dual coverage works, along with some related terminology and limitations to be aware of.
How does dual dental coverage and COB work?
When COB applies, one dental plan is designated as primary and the other as secondary. In most cases, the secondary policy will not accept a claim until after the primary policy has paid for services according to the enrollee’s available benefits under that policy. Then, the secondary policy will ask for a copy of the payment information (referred to as an explanation of benefits, or EOB) from the primary insurer.2
With dual coverage, your two carriers 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 carrier. This is known as the total allowed charge. In other words, the benefits from the two carriers combined do not exceed the total dentist charges and that duplication of benefits does not occur.
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 and state laws, you may: (i) receive benefits up to the full amount you paid for the procedure, (ii) experience a lesser co-pay than if you only had one plan, or (iii) receive no additional benefit from your secondary plan. Dual coverage limitations are built into your dental plan and into the rates your group pays for your coverage.
Here’s an example of how these limitations could work:
Let’s say that you have dual coverage and that each one of your plans happens to cover two cleanings per year, each with 75% coverage. As a result of dual coverage limitations, you can still only claim two cleanings per year – however, your primary carrier would pay the 75% cost of each cleaning (its maximum plan allowance). Depending on the language in the secondary carriers contract and state laws, after receiving the EOB from your primary carrier, your secondary carrier may cover up to the remaining 25% that you would have otherwise paid out of pocket (traditional COB language). It could also be a lesser amount, leaving you with a smaller co-pay than if you had just one single policy (maintenance of benefits language). Or, the secondary carrier may not pay the remaining 25% because their responsibility to pay 75% has already been met by the primary carrier (non-duplication of benefits language). Check your dental plan contract to determine how it would work for you.
How do I know which is my primary carrier?
The primary carrier is the one for which you are covered as the member (i.e.; dental insurance provided by your employer rather than your spouse’s). If you have two jobs, then the primary carrier is the dental plan that has provided coverage for longer.
When does the secondary policy pay? Usually, the secondary carrier will not accept a claim until after the primary claim has been paid. At this point, the secondary policy often will require a copy of the primary payment information or EOB. State laws and regulations often mandate COB in this situation.
Specific COB limitations will depend on your dental plans, insurance providers, state law, and other factors. If you have two dental insurance policies, then be sure to talk to both insurance carriers to fully understand if and how dual coverage could benefit you. Ask what their COB provisions are and what your entitled level of benefit is. You could also consult 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 prior to making any major dental treatment decisions.
Shopping for individual dental insurance or looking for more information? Brush up on dental insurance basics:
1 ADA. "ADA Guidance 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 Professional Success, 2020, https://success.ada.org/en/dental-benefits/dental-plans-coordination-of-benefits.