It’s not uncommon for people to have coverage under two separate dental plans. For example, your dependents may be signed up for dental benefits through both your employer and your spouse’s employer. Whether it’s yourself or your dependents, anyone with coverage under two separate dental plans has what is referred to as “dual coverage.”
The way insurance companies work together when a person has dual coverage is called “Coordination of Benefits.” This ensures that no more than 100 percent of the total covered expense is paid. First, the dentist bills the primary insurance carrier. The primary carrier pays its portion, and the remainder of the bill is sent to the secondary insurance carrier. In some cases, the secondary carrier may cover the rest of the bill, reducing your out-of-pocket costs. Dual coverage does not mean double benefits—if your plan covers two cleanings per year, for instance, dual coverage won’t cover four cleanings instead.
The insurance plan that is billed first is called the primary plan, and the insurance plan that is billed after the primary insurance has paid its portion is called the secondary plan. Which plan is primary depends on your individual situation.
• For yourself: If you have a plan through your employer, that is typically your primary plan. If you also have coverage through a spouse, that plan will be secondary.
• For yourself, if you have two jobs: If you have two jobs, and dental insurance through both employers, the primary plan is usually the one that has provided coverage the longest.
• For your children: If you have children with dual coverage, the parent whose birthday falls first in the calendar year will have the primary plan. For example, if your birthday is August 9, and your spouse’s birthday is July 21, your spouse’s plan would be the primary plan. Year of birth is not a factor.
• For children of divorced parents: Children who have coverage through both parents will typically have primary insurance through the parent with the most custody. However, there can be exceptions to this rule if a court deems it necessary.
Many employers use Delta Dental, so it’s possible that Delta Dental would provide both dual coverage plans, even if you and your spouse don’t work for the same company. If this is the case, don’t worry—dual coverage works the same way if both plans are through Delta Dental.
Coinsurance isn’t the same thing as dual coverage. In dental benefits, coinsurance is the percentage you pay for the cost of a procedure. For example, if the dentist charges $100 and your coinsurance is 20%, you would pay $20. Which is different than a co-pay, which is a fixed cost no matter the procedure.
Confused? We can help. Look through our handy infographic on benefits lingo, or give us a call toll-free during business hours at 1-877-841-1478. We’re happy to help!