Tuesday, May 24, 2022

Can You Be Double Covered For Dental Insurance

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Can You Have Two Health Insurance Plans

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Yes, you can have two health plans.

The most common example of carrying two health insurance plans is Medicare recipients, who also have a supplemental health insurance policy, says David Mordo, former national legislative chair and current regional vice president for the National Association of Health Underwriters.

Its also possible that a married couple could have two health insurance plans, even if each spouse is covered through a health insurance plan at their workplace.

Theyre both covered under their own policies with their companies, but one of the spouses decides to jump on their spouses plan, Mordo says.

You also might have two health insurance plans if you have health insurance but also receive Medicaid coverage. Or, perhaps you are under the age of 26 and have group coverage both through an employer and your parents health insurance.

Other examples of when you might have two insurance plans include:

  • An injured worker who qualifies for workers compensation but also has his or her own insurance coverage.
  • A military veteran who is covered by both Veterans Administration benefits and his or her own health plan.
  • An active member of the military who is covered both by military coverage and his or her own health insurance.

How Having Two Health Plans Works

When an insured person has two health plans, one is the main plan, and the other is the second one. In the event of a claim, the primary health plan pays out first. The second one kicks in to pay some or all of the costs the first plan didn’t pick up. For example, if your first plan has a deductible or co-pay, the second plan may pay for that.

Primary Vs Secondary Dental Insurance

When someone is covered by two dental insurance plans one is typically designated as your primary plan and the other as your secondary plan.

Your primary plan is the plan that will pay out benefits first. Generally, the plan that covers you as the primary account holder will be the primary plan, while the plan which covers you as a dependent will be your secondary plan.

If you are a primary account holder in more than one plan, such as a plan through your employer and a retirement plan, the employer-sponsored plan typically should be your primary plan. If you have plans provided by more than one employer, the plan that is covered you the longest typically is the primary plan. If you have dental coverage under both a medical and a dental plan, the medical plan typically is primary.

As for dependent children who are covered by both parents dental plans, typically the policy that pays first is decided by the dental plan or by state laws. Most plans use the birthday rule, which says the plan belonging to the spouse with a birthday occurring earlier in the calendar year is primary. Others automatically consider the fathers plan primary. If a dependent childs parents are divorced or separated, typically a court ruling takes precedence.

Heres a few suggestions:

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Primary And Secondary Insurance Rules

When you have two forms of health insurance coverage, your primary insurance pays the first portion of the claim up to your coverage limits. Your secondary insurance may pick up some or all of the remaining costs.

However, you still might be responsible for some cost-sharing. For example, its a mistake to think your secondary insurance will kick in and cover the deductible attached to your primary insurance. Instead, you likely will be responsible for covering the deductible.

You also may be responsible for copay and coinsurance fees.

Metlife Dental Ppo Dual Coverage

Full Coverage Dental Insurance details and explanation

If you have dental insurance plans from MetLife Dental PPO insurance and another carrier you may wonder how you can get the most benefit from both plans. Having double or dual coverage is a great thing to have, especially for people needing extensive dental work. Maximum benefit from the two policies can only be achieved when the claims are submitted and processed correctly.

The Sunnyvale Dental Care insurance coordinator submits many dental claims each day to multiple dental insurance companies including MetLife Dental PPO insurance. How will Sunnyvale Dentist Dr. Antonious and his team ensure that you get the most benefit from your two dental insurance policies?

Once you contact us with your insurance information they will contact MetLife Dental PPO insurance on your behalf and request details on your individual policy. They will also contact your second insurance carrier and request the same information. They will have your insurance data ready when you arrive for your first appointment.

During your initial consultation, Sunnyvale Dentist Dr. Antonious will do a thorough examination and explain his findings and recommendations to you. The two of you will come up with a treatment plan based on your needs and dental goals.

Learn more when you visit Sunnyvale Dental Care. Call Sunnyvale Dentist Dr. Antonious at 408-720-0900 to schedule a consultation today!

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Rules For Dependent Children

For your dependent children, your birthday determines which plan is considered the primary coverage. If a child is covered under a plan by each parent, the parent with the earliest birth month of the year provides the primary coverage. For example, if you were born in February and your spouse was born in October, your plan is considered your child’s primary coverage, regardless of the birth year. In the event of a divorce, a court order will generally establish coverage.

How To Use Two Dental Plans

Coverage under two different dental plans is known as dual coverage. If you’re fortunate enough to have dental insurance coverage through two different carriers, you may combine the plans to minimize your out-of-pocket expenses. When plans contain a Coordination of Benefits provision, both carriers will communicate to determine benefits and payments. Although you can combine dental insurance plans, there are restrictions when using discount dental savings plans.

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Will You Receive A Bill Or Pay In The Office

You may have a copay or coinsurance that you need to pay in the dentist’s office during your visit, depending on your plan type. If you owe anything for your visit, you may be asked to pay a portion or all in the office or receive a bill this will depend on your dental office’s billing practices. Log in to your account for more information.

Understanding The Coordination Of Benefits System

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The health plan coordination of benefits system is used to ensure both health plans pay their fair share. When both health plans combine coverage in the right way, you can avoid a duplication of benefits, while still getting the health care to which you’re entitled.

Health plans combine benefits by looking at which health plan is the patient’s main plan and which one is the backup plan. There are guidelines set forth by the state and health plan providers that help the patient’s health plans decide which health care plan is the main plan and which one is the second plan.

If you have two health plans, you may be asked to declare which one you want to name as your main plan. Do your research to decide which plan will work better as your main plan.

Once you’ve named one plan as your first plan, that plan will pay what is required of it without looking at what the second plan covers. Once the main plan has paid the costs it has to pay, the second plan will be used.

Your second health plan, unlike your first plan, can look at what health care service was provided to you by the main plan. The health care costs that are still due will then be looked at for payment under the second health care plan.

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How Does Coordination Of Benefits Work

Have a look at the coordination of benefits provision in both policies. This will stipulate how your expenses are reimbursed. Usually, you start with your own coverage first. The excess may be claimed under your spouse’s plan.

Let’s say your plan covers 70 percent of certain vision care expenses, and your spouse’s covers 50 percent. You can get 70 percent of your costs reimbursed by your own insurer, and the remaining 30 percent through the other plan. You can’t get back more than you’ve actually spent, and your plan’s maximum dollar amounts still apply.

How Does Primary And Secondary Vision Insurance Work

The primary plan pays its share of the costs first. Then, the secondary insurer pays up to 100% of the total cost of care, as long as its covered under the plans. The plans wont pay more than 100% of the treatment cost, so youre not going to get double the benefits if you have multiple health plans.

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Can You Have More Than One Health Insurance

Not exactly, but having two or more health insurance plans does help cover any health insurance expenses better through the coordination of benefits provision. The most common example is when two spouses or domestic partners have health insurance and both of their employers provide a health insurance plan.

Dual Dental Coverage: Can I Have Two Dental Insurance Plans

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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 spouses 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 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, well explain how dual coverage works, along with some related terminology and limitations to be aware of.

How does dual dental coverage and COB work?

Will I receive twice the benefits?

Heres an example of how these limitations could work:

How do I know which is my primary carrier?

Final thoughts

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Will I Still Have Out

If you have multiple health insurance policies, youll have to pay any applicable premiums and deductibles for both plans. Your secondary insurance wont pay toward your primarys deductible. You may also owe other cost sharing or out-of-pocket costs, such as copayments or coinsurance.

Even if you have multiple health insurance policies, remember that plan rules still apply. For example, if youre in a PPO plan, your primary policy may have provider network rules. If you see an out-of-network provider who isnt covered by your plan, your primary insurance wont cover the costs and your secondary insurance wont cover the costs because you didnt follow your primary plans rules.

As another example, you may have out-of-pocket costs if your provider charges you more than your plan consider reasonable, customary, or allowed under plan rules. If youd like help understanding different out-of-pocket expenses you may have with more than one plan, an eHealth licensed insurance agent can explain those costs.

How Does Eyeglass Insurance Work

How Vision Care Insurance Works. When you have vision care insurance, you send the vision insurer a check for your premium for individual plans or have the premium deducted from your paycheck for employer-sponsored plans. In exchange, youll receive benefits such as discounted vision exams, glasses, and contacts.

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Primary Insurance Vs Secondary Insurance: Who Pays First

Coordination of benefits isnt always standard. Plans can differ, so its vital to talk to your employers benefits department and health plan if you have two health plans.

That said, here are situations when you may have more than one health plan and which one would likely be the primary insurer and which would be secondary:

Situation

Is Double Health Insurance Coverage Better

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You have just gotten a job offer that includes health insurance. Youre lucky enough that your spouse has great family insurance already, but hey that health insurance is going to cover the cracks in the deductible and co-insurance, so you feel great about that double coverage as you sign your contract.

Well, you just got scammed. That is, double coverage is a scam, and you would have been far better off negotiating a higher salary in return for not getting insurance.

Heres why:

Lets say policy A has a deductible of $1,000 and 75% coinsurance up to an out of pocket max of $3,000.

Policy B is identical, with a deductible of $1,000 and 75% coinsurance up to an out of pocket max of $3,000.

So you get $500 in health care. It costs you $500 because neither policy pays up to the first $500

Then you have a surgery that costs $5,000. The first policy pays $4,000 on this . So that leaves you with a $1,000 bill. That bill gets submitted to your second policy, which also has a $1,000 deductible. So you still have $500 to satisfy there, and so the second policy pays you $500, or if youre unlucky in how they interpret the secondary coverage, $375. So policy A pays $4,000, and policy B pays $375 to $500.

This has always seemed wrong to me. If you have two life insurance and you die, your family gets paid twice. But if you have two health insurance policies and you get sick, you only get paid once, or maybe once and a little more.

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Where To Find Your Claim Statements

If you have elected to receive claim statements and other plan documents by mail, you should receive them in the mail after your visit to the dentist if there is a balance due. However, you can also access your claim statements and other documents at any time by logging in to your online account. Your claim statements can be viewed and downloaded as PDFs by navigating to the Plan documents section.

A claim statement will show information related to your dental plan usage, including the date and type of service you received, how much it cost, and your portion of the bill plus what Delta Dental pays.

Travel Insurance Through Your Bank Account Or Credit Card

Its essential that you know what insurance you have in place and whether you need additional cover, said GoCompares travel expert, Sally Jaques.

If youre off on a skiing trip or planning a long-term break, you might not have enough cover from your bank accounts travel insurance policy.

When it comes to finding the right travel insurance policy for your needs, check:

  • What youre covered for
  • Whether you have enough cover
  • What the excesses are
  • Whether the country youre travelling to is included
  • What the insurers contribution clause is and how you would be affected if you need to make a claim

You’d easily think that having more insurance is better, but thats not usually the case. Over-insuring could result in you paying more at renewal should you make a claim

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Can I Have Dual Coverage For Braces

The answer is yes in most cases but there are a few rules insurance companies follow when determining primary vs. secondary and you want to make sure your plan allows for standard coordination of benefits. The birthday rule determines whose plan is primary and looks at what month the person is born in. For example if moms birthday is 2/14/73 and dads birthday is 11/20/1968, moms plan, in most cases, would be considered the primary insurance plan because her birthday falls first in the calendar year.

Overall age or who is older does not generally determine who is primary. Be sure to ask if your plan allows for standard coordination of benefits or has a non-duplicating clause. A non-duplicating clause means benefits will not be duplicated. So if both plans have a LTM of $1500 then with a non-duplicating clause your total benefit is $1500. When coordination of benefits is allowed your benefit could be as high as $3000 if the LTM for both plans is $1500.

How Having Multiple Health Insurance Policies Works

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Having multiple health insurance policies doesnt mean you get reimbursed twice for a doctors visit or two bottles of medication. If you have more than one plan, the total amount that your plans pay will never exceed 100% of the cost. Its important here to understand the difference between primary versus secondary insurance.

If you have more than one health plan, coordination of benefits is the process that decides which insurance pays first for a claim. Heres where primary versus secondary insurance comes in:

  • Primary insurance: the insurance that pays first is your primary insurance, and this plan will pay up to coverage limits. You may owe cost sharing.
  • Secondary insurance: once your primary insurance has paid its share, the remaining bill goes to your secondary insurance, if you have more than one health plan. Your secondary insurance may cover part or all of the remaining cost.

Note that both the primary and secondary insurance will cover up to plan limits. After the secondary insurance has paid its share, you may be responsible for any remaining amount that wasnt covered. So, even if you have multiple health insurance policies, you may still have leftover out-of-pocket medical costs.

If youre concerned about your out-of-pocket costs, taking the time to shop and compare health plans may help. eHealths plan finder tool makes it easy to compare plan costs like premiums, deductibles, and copayments side by side.

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