Understanding dual coverage

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August 23rd, 2018

If you’re covered by two dental benefits plans, you have dual coverage. It’s not uncommon, but it can get a little complicated. Here’s how it works:

1. Coordination of Benefits

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,” and the plan 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. One plan pays first

For children, 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 15 and your spouse’s birthday is December 1, 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.

If you have dual coverage because you have two jobs,

the plan you’ve had for the longest will be your primary plan.

3. Dual coverage is not 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. Non-duplication of benefits clause

Some plans have a rule that prevents the secondary plan from providing coverage if the primary plan has already paid more than or the same amount as what the secondary plan would have paid. Check your plan information to see if your secondary plan has this rule before using your benefits.

Confused about other aspects of your dental plan? Check out our Delta Dental 101 page to help you understand your benefits.