Wednesday, June 15, 2022

How Does Dual Coverage Dental Insurance Work

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Advantages Of Dual Coverage Dental Insurance

How does Dental Insurance work?

The main advantage of dual coverage is that it may save you money on dental care. If the primary plan doesnt cover a certain treatment or covers it only partially, the secondary plan could cover some or all of the remaining balance .

Heres an example of coordinating benefits with dual dental coverage:

  • You go to the dentist for a filling. The dentist charges $100 for that service and submits the claim to both insurance companies.
  • Your primary plan covers fillings at 90% and issues a check to the dentist for $90.
  • Typically, youd receive a bill for $10, but you have dual coverage. Your secondary plan covers fillings at 80% of the cost.
  • The secondary plan issues a check for $8 of the $10 balance to the dentist.
  • You receive a bill for the remaining $2, plus any applicable deductibles.

What Does Supplemental Dental Insurance Cover

If you have a dental insurance plan through your employer or have purchased an individual plan, that plan is known as your primary plan. Whenever you have any dental treatment done, you or your dental provider sends a claim to your primary plan. Depending on the details of the plan, the primary plan typically pays for all or part of the charges.

If the primary plan pays only a part of the charges, then your supplemental dental insurance plan can help cover either all or part of the remaining balance of your dental bill provided it is an approved dental service. Supplemental plans will not accept a claim until after the primary plan has paid the claim. This is known as coordination of benefits .

For example, if you have a crown procedure that costs $1,000 and your primary insurance pays $500, you can submit a claim to your supplemental plan after the primary has finished paying. Depending on the benefits specified in your plan, the supplemental insurance may pay some or all the remaining $500 balance.

Dental insurance purchased as a supplemental plan typically provides specific amounts of coverage for a variety of dental services, similarly to a primary plan. It is important to understand the services coveredfor example preventive, restorative, major, endodontics, surgery, orthodontics and the amount of the benefits before signing up for a supplemental plan.

How Does Coordination Of Benefits Work

Lets say you visit the dentist to fill a cavity and your dentist charges $100 for fillings. Your primary dental plan covers fillings at 80 percent and your secondary plan covers fillings at 90 percent.

Your dental office will send your dental claim to your primary dental plan. Since your primary plan covers fillings at 80%, and it was a $100 filling, your primary plan will pay your dentist $80.

Normally, you would owe $20 to your dentist.

But, since you have more than one dental plan, you can have your secondary dental plan process your claim for the remaining $20. Since they cover fillings at 90 percent, they will pay 90 percent of $20.

In this example, your secondary plan will pay your dentist another $18 and you will owe your dentist $2 for your filling.

Examples would differ if deductibles applied.

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How To Pick The Best Supplemental Dental Insurance For You

Frequently, circumstances dictate the dental insurance plan that you end up with, either through an employer or through the Marketplace. However, you may also opt for supplemental dental insurance products, just because of the potential advantages they offer. The guidelines for choosing the best secondary policy are the same as choosing the best dental insurance overall, with a couple of edits:

  • Understand the different types of insurance plans: Not all insurance plans operate the same way, so understanding the difference between PPO and HMO plans can be key.
  • Evaluate your needs: What are your situation and needs? If youre getting a second plan, you might be expecting some steep dental expenses, so coordinating waiting periods and other aspects can save you money.
  • Consider costs and budget: The goal is affordable coverage for dental care, so do the math and add up your premium costs, understand each waiting period, and work out how much youll end up paying for major dental work.
  • Understand the basics of coordination of benefits: The secondary plan may not always have to contribute and the size of their contribution can vary. Thats decided in the coordination of benefits process.

Who Is The Primary Carrier

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The first or primary carrier is the one that covers you as a primary enrollee . If you have two jobs, the plan that has covered you longer is considered primary.

For your childrens coverage, the primary carrier is generally determined by the birthday rule: coverage of the parent whose birthday comes first in the year is considered to be your childrens primary coverage. For example, if the mothers birthday is in April and the fathers birthday is in September, the mothers plan would be the primary coverage for the childrens claims. The birthday rule may be superseded by a divorce agreement or other court ruling.

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Why Not Twice As Many Benefits

Why dont you receive double the benefits when you have two dental plans, especially if your dentist recommends that you receive more than two cleanings per year?

Dual coverage limitations, like all other plan limitations, are built into your groups contract and into the rates your group pays for your coverage. These contracts are set up to provide affordable dental care to a maximum number of people. Given the choice between doubling one individuals benefits or providing a greater scope of benefits to more people in the group, most group purchasers choose to spread their benefit dollars more evenly.

Q: Are Health Insurance And Dental Insurance The Same Thing

A: Not exactly. A general health insurance plan may include some dental benefits, but not all do. It’s important to check the fine print for this aspect of coverage when choosing a healthcare plan. If you’re already covered, you can call your provider for a detailed rundown. And if you’re covered through work, your human resources department can help answer any questions, too. Whatever your coverage, whether you’re not covered at all, covered by an individual plan or covered through your employer, we have some additional information about affordable dental care, as well.

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Which Dental Plan Is Primary

The primary plan always processes and pays your claims first. The secondary plan then pays toward the remaining cost, only if their coverage for your treatment is higher than your primary plan.

The Washington State Office of Insurance Commissioner has rules that govern how we coordinate your benefits with other carriers.

It can get complicated, but here are the general guidelines:

  • When both plans have COB provisions, the plan where youre listed as the main policyholder is primary. The plan where youre listed as a dependent serves as the secondary. Example: You are the policyholder on the dental plan provided through your employer. You are listed as a dependent on the dental plan provided through your spouses employer. Therefore, for your claims, your employers dental plan is primary and your spouses dental plan is secondary.
  • If a dependent has coverage through you and another parent/guardian, the parent/guardian whose birthday falls first in the year is the primary plan. The parent/guardian whose birthday falls second serves as the secondary plan. Example: Your birthday is March 4 and your spouses birthday is September 7. For your childs claim, your dental plan would be primary and their plan would be secondary.

The guidelines listed above are those that pertain to regular book plans. There are plans that specifically state whether they are always primary or always secondary. They include:

What Is Supplemental Dental Insurance

What Dual Coverage in Dental Insurance Means

Medical or health insurance rarely covers dental treatment except for emergency care such as dental treatment that is needed after a car wreck or other type of accident. Traditional Medicare, the federal insurance program for senior citizens, does not offer any dental coverage.¹

Supplemental dental insurance is available to help pay for dental treatment. Whether you have an employer-sponsored health or dental plan, an individual plan, or are a senior citizen covered by Medicare, you can purchase supplemental dental insurance directly from an insurance company, through a broker, or on the Affordable Care Acts marketplace.

Having a supplemental dental insurance plan in addition to your medical coverage helps you to get regular dental care from a dentist. Regular dental check-ups help to prevent serious dental conditions from occurring, which are expensive to treat.

A supplemental dental insurance plan can also support your existing dental plan if its benefits are not sufficient to cover the dental care needs of you and your family.

Another advantage of having a supplemental dental insurance plan is to provide benefits for services that your current plan may not cover, called restrictions or exclusions. For example, if your current plan does not cover adult braces , you can find a supplemental plan that specifically covers braces for adults. You can typically use the supplemental plan, in conjunction with your primary dental insurance, to help pay for your orthodontic care.

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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

What Is Coordination Of Benefits

Coordination of benefits is the procedure your insurance companies use to determine which one covers procedures first and which plan picks up as secondary. This cannot be set-up per preference of the patient, it is set-up by specific guidelines.

Always make sure your two plans will coordinate. There are some plans that do not allow coordination unless the primary plan has been exhausted.

There are some instances to keep in mind as well when coordinating plans. Health Care responsibility and Divorce Decrees are always used to determine primary coverage in the coordination process.

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Can You Be Covered By Two Health Insurance Plans

Yes, you can be covered by two health insurance plans.

In some cases, each member of a couple might have health insurance through their employer. Children up to the age of 26 also might have coverage through their employer and their parents.

It is also possible for others such as members of the military and those who are on Medicare but are still working to have more than one form of coverage.

However, being covered by two plans is the exception to the rule. If youre covered by one solid employer-based health insurance plan, thats usually sufficient for most people, Mordo says.

Youre really not getting any benefit by being covered by two different employer-based plans, he says.

Primary + Secondary Dental Insurance

How will kids

Let’s have a chat. For real, we gotta chat. There is some seriously mixed information running around town about primary and secondary insurances and once and for all, we want to be the resource that helps bring clarity to this confusing topic. This is a 6-minute read you need to take the time to look over.

Let’s go.

What if my favorite unicorn patient walks in with two dental insurances?

Do I wave the white flag of surrender?

Do I tell them the age-old phrase “We are just a 3rd party, how your insurance works is between you and your insurance company, we are filing this claim as a courtesy… figure it out.”Do I tell them, we don’t process secondary claims?

No ma’am/sir, and we can teach you exactly how to process dual insurance.

Personally, it’s our opinion dental offices across the nation have become accustomed to these phrases, quotes, lines, and what have you because we simply just do not know how to process dual insurances. So, here is a bunch of free carrots for you today. Oh, and if we beg please don’t be one of those “I know everything” people with the hopes of proving it wrong, we went to the experts like the ADA, Delta Dental, and the National Association of Insurance Commissioners for this information. We worked hard to put this together and want to bring you all the good stuff we possibly can. Let’s be here to encourage and build each other, not break down and criticize 🙂

Alright, let’s do this…

How dual coverage works

Types of coordination of benefits

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Coordination Of Benefits : Does Your Patient Have Dual Dental Insurance Coverage

When a patient has dual insurance coverage, the two insurance companies will, in most cases, coordinate benefits for the patient this process is called Coordination of Benefits . In order for DDKS to coordinate benefits with another insurance company, the patient must complete our Dual Coverage Information Request form by visiting, DeltaDentalKS.com/Forms or by completing the online form by signing in to their member account so that we know what other insurance company we need to work with, and which plan will pay first, second, etc.

How Does It Work?

When a patient is covered by more than one dental plan, one plan will pay first , and one plan will pay second and so on. Here are two of the many rules about the order in which plan benefits pay:

  • The patients plan through his or her employment is primary and the plan through the spouse is secondary.
  • For dependent children, the birthday rule is used when the parents are married or living together. This means that the dental plan covering the parent whose birthday occurs earlier in the calendar year will be the primary plan and the plan covering the parent whose birthday falls later in the year will be the secondary plan.

Things To Remember

Standard Coordination of Benefits:

Procedure: Filling

Can You Have Two Dental Plans

You can have two or more dental insurance policies, though it isn’t necessary. If you are fortunate enough to enjoy dual coverage, it can help you save on out-of-pocket costs, avoid lapses in coverage, and feel covered in the case of a dental emergency.

Weve compiled a few resources full of information, tips, and insights on how you can make sure you have enough dental insurance coverage, whether with two plans or just one.

  • Are you worried your existing dental plan doesnt provide sufficient benefits? Learn how supplemental dental insurance can support your medical or dental plan.

  • Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care, and even experience greater overall health.² Learn whether dental insurance is really worth it for you and your family.

  • Dont have any dental insurance coverage yet? Dissatisfied with your current level of coverage? Getting individual dental insurance directly from an insurance provider might be a good place to start.

  • How much does dental insurance cost? Learn more about the out-of-pocket costs youll have to budget for in each plan.

  • Ready to purchase a high-quality dental insurance policy to supplement or replace your current plan? Get a free online dental insurance quote.

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist’s office.

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Can You Have Two Health Insurance Plans

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 Does Dual Coverage Work

How dental insurance works

Since dual coverage is just another term for having secondary dental benefits, it works just as weve already discussed. However, a quick step-by-step review might help clarify a fairly complex topic. While theres a lot more to it, using secondary insurance can be broken down into three steps:

  • Obtain secondary insurance: You end up with two dental plans, either by planning or circumstance. You decide to take advantage of things like different waiting period times, more coverage for expensive procedures and major services, and a wider choice of providers.
  • Determine primary insurer: Once you use your benefits, the insurance companies decide which is the primary insurer, responsible for covering the large part of dental care and services.
  • Coordination of benefits: The two insurers decide how much they each contribute to coverage.
  • Here are some simple answers to common questions on secondary dental insurance.

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    Secondary Dental Insurance: A Complicated Way To Save Money

    • Posted on 4/02/2022

    Even the best insurance plans dont cover everything. In the US, over 47% of Medicare beneficiaries dont get dental coverage. A secondary dental insurance plan, whether obtained through choice or circumstance, can reduce your costs substantially. However, using a second policy wisely is complicated and requires a basic understanding of the administrative side of insurance.

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