Twice the insurance coverage does not mean twice the benefits. With dual coverage, you cannot combine the services. However, having two insurance policies can help cut your out-of-pocket expenses. When you have two dental insurance policies, one acts as a primary and the other as a secondary form of coverage. In most cases, the secondary policy pays all or a portion of what the primary policy leaves behind.
Coordination of Benefits
States require insurance companies to include a Coordination of Benefits provision within dental plans. The provision is designed to specify the order in which insurance plans pay in the event of dual coverage. With a traditional coordination of benefits, the two companies coordinate coverage to pay up to 100 percent of dental expenses. Certain policies contain a non-duplication of benefits provision to ensure the insurance payout is not greater than the actual cost of treatment or services. If the primary carrier paid the same amount the secondary would have paid, the secondary is not responsible for any payout. The carve-out coordination of benefits method calculates the payout by subtracting the primary payout from the normal benefit amount the secondary insurance would normally pay.
Establishing Primary and Secondary Plans
The plan that covers you through your employer is considered your primary plan. If you are also covered under your spouse or domestic partner's policy, that plan is considered secondary coverage. If you have coverage through two jobs, the coverage held the longest is the primary plan. If one plan is through current employment and the other through a retiree plan, the current employer is primary.
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.
You will need to submit a benefit claim to both insurance companies. Indicate that you have dual insurance coverage and include specific details about the other policy on both claim forms. When submitting your claim to the secondary insurance company, you will also need to include an explanation of benefits from your primary insurance policy. Once the primary insurance pays, the secondary insurance will pay the remaining amount under the specified coordination of benefit guidelines.
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