Understanding the ins and outs of dual coverage

It’s not uncommon to be covered by two dental benefits plans, which means that you have “dual coverage.” If this applies to you or your family members, take a moment to learn how dual coverage works with these four key points.

1. Understand your coordination of benefits (COB).

Your COB is the way your two plans work together when you have dual coverage. The plan that pays first is called the “primary plan,” while the one that pays second is called the “secondary plan.” When your dental office sends a bill, they will address it to the primary plan provider. After the primary plan provider has paid, the remainder of the bill will be sent to your secondary plan provider. In some cases, the secondary plan may cover the rest of the bill.

2. Figure out which plan pays first.

For kids, the primary plan provider can be determined in a couple of ways:

      • If you’re currently married and your kids have dual coverage, their primary plan will be based on your and your spouse’s birthdays. The parent whose birthday comes first in the year (regardless of birth year) will have the primary plan. For example, if your birthday is June 15th and your spouse’s birthday is December 1st, yours would be the primary plan.
      • When parents are divorced, a child’s primary plan typically comes from the parent with the largest portion of custody. It’s best to check with your benefits provider because this may vary depending on your situation.

If you have dual coverage because you’re married, the coverage you receive under your employer is your primary plan, as opposed to the coverage you receive from your spouse. Alternatively, you might have dual coverage because you have two jobs. In this case, the plan you’ve had for the longest will be your primary plan.

3. Don’t expect double coverage.

Dual coverage means your two benefits providers share costs in a pre-determined way – not that you receive double benefits. For example, both plans may cover two cleanings a year, but having dual coverage doesn’t mean that you’re now covered for four.

4. Know if your plan has a non-duplication of benefits clause.

Some plans have a rule that prevents secondary plan coverage when the primary plan already paid as much or more than the secondary plan would have covered if it had been the primary plan. Check your plan information to see if your secondary plan has this rule before using your benefits.

With some quick research, you can handle dual coverage with ease and know what to expect after you visit the dentist.


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