You can either keep both plans and combine benefits to retain dual dental insurance, or choose one of your employer’s plans to cover both of you (if you’re both eligible).
Figuring out which option is best will require a cost comparison of premiums, deductibles, co-pays and coverage options. If you choose to keep both plans, you’ll have to see if each of your employers’ plans allow for duplicate benefits and dual dental coverage.
Here’s how you can compare your and your spouse’s dental plans so you can choose the option that provides the coverage you need at a price you can afford.
Which is the primary plan?
If you decide to receive medical coverage from both of your employer health insurance plans, the primary plan is the one which will pay for coverage first. Generally, the plan that covers you as an enrollee is the primary plan, and the plan which covers you as a dependent is the secondary plan.
For your dependent children’s coverage, typically the primary insurance company is determined by the birthday rule: coverage of the parent whose birthday (month and day, not year) comes first in the year is considered your children’s primary coverage. A divorce agreement or other court ruling may supersede the birthday rule.
Rules of dual coverage
Your plans may provide equal coverage for certain procedures, but which plan pays for what?
Your primary plan pays its benefit as if you have no additional insurance plan. If your primary plan and your secondary plan cover two dental cleanings a year, you would only be covered for two dental cleanings, not four.
The secondary health plan is supplementary to your primary plan, which may cover some remaining out-of-pocket expenses.
For example, if both the primary and secondary carrier pay 80% for a bridge, and the primary plan covers $100, while the secondary plan covers $80 for the same treatment, the secondary plan would not make any additional payment.
On the flipside, if the primary plan only pays for 50% of a procedure, while the secondary plan covers 80%, then the secondary plan could reduce your additional out-of-pocket costs. The secondary plan’s exact coverage amount is based on its coordination of benefits and non-duplication of benefits rules.
Non-duplication of benefits rule
Some dental plans have a “non-duplication of benefits” clause which applies when you have more than one dental insurance plan. This means your secondary health plan will not pay any benefits if the primary plan paid the same amount or more than what the secondary plan allows for the same procedure and dentist.
For example, if both plans cover 70% on a tooth extraction, you will submit your bill to your primary plan to receive the 70% reimbursement. You can then submit your remaining balance to your spouse’s secondary plan, but your spouse’s plan may pay little or nothing, depending on their coordination of benefits or non-duplication of benefits rules.
Which is cheaper?
The cost of covering your spouse or child as a dependent on your employer’s plan is typically cheaper than paying the premiums of an individual insurance plan.
If your employer charges a high premium to cover dependents, it may be worth it for you and your spouse to keep your own employer’s health insurance plans as your only health plans.
Additionally, if the reimbursement from your spouse’s plan isn’t large enough to justify the additional premium costs, being a dependent on your spouse’s secondary plan may not be worth it.
For dependent children, you may want to investigate the cost of an individual health plan if including them on your employer’s plan is too expensive.
How long will your employer’s plan cover your spouse?
You and your spouse may have annual enrollment periods for your employer health plans at different times, so you should prepare to ensure there is no gap in coverage for you and your family.
Coverage for leave of absence is another factor to evaluate in each plan. If one of you is planning to leave work for an extended period, such as for maternity or paternity leave, it’s important to know if your employers’ health plans will cover you during this time.
If your or your spouse plans on quitting your current job soon, you’ll need to know your coverage options through the primary or secondary health plan. The terminating spouse may be eligible for COBRA coverage for up to 18 months after leaving their job.
However, it may be more beneficial for the terminating spouse to consider getting coverage as a dependent under the other spouse’s plan, as it may be less expensive than a COBRA plan and may extend longer than 18 months.
Individual plan options
You are not required to participate in your employer’s health and dental plans. If either yours or your spouse’s plan doesn’t provide the coverage your family needs, or if your plans are simply too expensive, you can purchase an individual dental insurance plan on your own.
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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.10/21)