Nearly 25% of Americans do not have any dental insurance¹, yet many adults are fortunate enough to be covered by not just one, but by two or more dental insurance policies. Though dual dental coverage isn’t very common, it most often occurs when two spouses both receive dental benefits from their employer.
What is secondary dental insurance?
Secondary dental insurance is a dental insurance policy that covers you in addition to your primary dental insurance. If you are covered by two insurance carriers, your primary dental plan will be the one that covers you as the main policyholder and the secondary dental plan will be the one that covers you as a dependent.
Having secondary insurance doesn’t mean you will receive twice the benefits, but in some cases, your secondary insurance can kick in to help you save on out-of-pocket costs after your primary dental insurance has paid.
Your combined dental insurance plans will typically not pay more than 100% of any procedures you undergo. A process called coordination of benefits (COB) determines which plan pays what for dental care, ensuring that the cumulative insurance benefits don’t exceed 100% of the total charges². Most plans have a COB clause indicating how benefits will be paid if you have multiple insurance policies. In other cases, state laws and regulations might determine the coordination of benefits or insurance companies might coordinate benefits together.
What is dual coverage?
Dual coverage allows a person to access both insurance plans to help cover their dental claim costs. However, dual coverage is not double insurance coverage. If each of your plans covers two cleanings a year, you will only be covered for two cleanings a year—not four. If each of your plans covers preventive care at 100%, you will not have to pay anything out of pocket for the procedure, but you won’t get any extra money put in your pocket either. If each of your plans covers major procedures up to 50%, they won’t be covered 100% (though in total, your insurance companies may pay out more than 50% in the end.)
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 father’s plan primary. If a dependent child’s parents are divorced or separated, typically a court ruling takes precedence.
Your primary plan typically pays out any designated benefits as though you had no additional insurance plan. After that, your secondary insurance can come into play.
if you are covered by two dental insurance policies, your secondary plan may not pay out benefits automatically. You will have to be proactive about submitting claims to receive the benefits you’re entitled to.
Here’s a few suggestions:
Submit the claim to your primary provider. First, submit your dental insurance claim to your primary provider, just as you would if you did not have multiple insurance plans. Depending on your provider, this may involve filling out some forms and paperwork. (If you have a Guardian Direct® dental insurance plan, you don’t have to fill out any paperwork at all when you visit an in-network dentist.)
Submit the claim to your secondary provider. Once you receive notice that the claim has been accepted and paid, submit the claim to your secondary insurance company. Be sure to include a receipt from the first provider as proof of what’s already been paid.
Be patient & check your policy. Depending on your policy, the secondary insurance company may pay all or part of the remaining balance. Go over the terms of your insurance policy so you have a good idea of what to expect.
Receive your benefits. If your secondary provider approves the claim, you may receive reimbursement for some or all your out-of-pocket expenses associated with the procedure. Remember, the exact amount your secondary plan pays will depend on its COB clauses and non-duplication of benefits rules.
Non-duplication of benefits rules
Some dental insurance plans have a non-duplication of benefits clause that applies when you have more than one dental insurance plan. This means that if the primary plan already paid the same amount or more than what the secondary plan allows for the same treatment, the secondary plan will not pay out any benefits.
Some dental insurance plans use a maintenance of benefits clause. This reduces covered charges by the amount the primary plan has already paid, then applies the plan deductible and co-insurance criteria.
Other plans use a carve-out coordination method. This first calculates the plan benefits that would have been paid, then reduces the amount by the amount already paid by the primary plan.
Check your secondary policy’s terms to see whether they have a carve-out, maintenance of benefits, or non-duplication of benefits clause written in.
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.
We’ve 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 doesn’t 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.
Don’t 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 you’ll 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.
Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
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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https://insider-update-online.com/2021/03/uninsured-dental-populations/, 2021, last accessed August 2021
https://www.mouthhealthy.org/en/dental-care-concerns/if-you-have-two-dental-plans, last accessed August 2021
Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.10/23)