If you have your own dental coverage as well as coverage under a spouse’s or parent’s plan, you have what insurers call “dual coverage” or “dual dental.” And this is a good thing, as it can help reduce out-of-pocket dental costs. However, it can be somewhat complicated.
Your “primary” plan. Your primary plan could be your private dental coverage or dental coverage provided by your employer. It’s the one that pays as if no other coverage is in place; if you do have dual coverage, your primary is the plan that pays first.
Your “secondary” plan. The other dental insurance – your secondary plan – usually will not pay until it confirms the amount paid by the primary, and then may pay all or part of the remaining amount.
Coordinating benefits. Most plans have a “coordination of benefits” clause that indicates which plan pays first, and spells out any special rules regarding payment. If one plan does not contain this clause, that plan is usually the primary.
When both plans contain a coordination of benefits clause, whichever one covers you directly is the primary. This could be your employer’s plan or Medicare, for example. In your secondary plan, you’re usually the dependent, as you would be on your spouse’s employer plan.
Dual plan doesn’t mean twice the benefits. Most insurers coordinate the benefits of both plans to reimburse you up to 100%. But your dual dental plans will not reimburse for you more than 100% of your costs. If, for example, each plan provides for two dental cleanings a year, you can’t double the cleaning benefit to get four. And if your secondary plan has “carve-outs,” such as a “non-duplication-of-benefits” clause, you may still have some out-of-pocket expenses. How the state requires insurers to coordinate benefits may also affect your payment.