Many patients enjoy the privilege and advantages of dual coverage. This primarily happens because a patient might be holding two jobs that offer dental benefits. A patient can get dual coverage also through coverage of the spouse’s dental plan.
One needs to note that having dual coverage does not mean the doubling of benefits. In such situations, a patient could pay a lower amount for dental procedures if otherwise covered by just a single plan. This is because the treatment costs are shared by two plans and can be covered to a maximum of 100%.
A situation whereby a patient is covered by two dental plans is termed as supplemental dental coverage and the two plans can be referred to as a primary dental insurance plan. This plan has been acquired as an employee of an organization. A patient can then acquire an additional secondary plan individually or through coverage by the spouse.
Primary and secondary insurance benefits for a patient are possible through both the plans and this can result in enhanced dental coverage. A patient will thus not get insured or reimbursed more than the total cost of treatment. The insurance companies will decipher coverage for the patient based on the COB or coordination of benefits. This helps to determine the primary plan or which plan pays first. This also enables to speed up the processing of claims.
The primary plan for a patient is the one where there is coverage as a member. Dental insurance has been provided by the employer and not by the spouse’s dental plan. If a patient has two jobs, then the dental plan that is in existence longer will be considered as the primary plan.
Coverage from the secondary plan begins only after the primary claim has been processed and paid. To facilitate payment, the insurance company offering the secondary plan would need a copy of the primary payment information. The coordination of benefits is governed by state laws and regulations.
The basic benefits of dental insurance coverage are based on the primary plan. It covers all treatment expenses that the patient needs to bear. The patient, however, will be liable for payment of any deductibles or copayments before the insurance organization provides coverage for the costs incurred.
Most primary plans offered by a patient as part of the employer’s benefits package cover preventive dental care that includes check-ups, routine cleanings, and X-rays. It could also include complex or expensive dental procedures like fillings, crowns, and root canals. These plans also have an annual maximum limit on the benefits that can be received.
The quantum of coverage available for a complex procedure depends on the specific insurance plan as some cover a portion of the expenses while the patient would need to pay the balance amount.
A secondary insurance plan enhances the primary dental plan with supplementary benefits for services and procedures that are not covered by the primary plan. A patient can utilize such a plan when procedures and treatment surpass the maximum coverage limit of the primary plan.
One needs to note that not all insurance plans offer secondary coverage. A patient can avail of coverage through a secondary plan only if the primary dental insurance plan permits secondary coverage.
The dental practice needs to understand the terms and conditions for treatment acceptance and costs when a patient has any queries. Hence, a thorough comprehension of primary and secondary dental insurance rules is vital.
The principal advantage of having a primary and secondary dental insurance plan is that it expands the scope of coverage and enables the patient to avail of a broader range of dental procedures and services.
The primary plan of the patient can cover any preventive care or major dental procedures. In case, the maximum annual limit is reached, the patient can avail coverage through the secondary plan.
Dual plan coverage enables a patient to enjoy a lowered out-of-pocket expense for any unanticipated or supplementary dental procedures that would be needed.
Through a coordination of benefits, the two-plan coverage ensures access to special or complex procedures whereby the primary plan covers the cost and any balance dues get covered by the secondary plan.
A patient needs to select from a specific network for a primary dental plan. A secondary plan, however, offers more flexibility and enables a patient to make a choice from multiple dental practices.
Paying a premium for two dental plans can be steep for a patient but it can result in substantial long-term savings. This could differ from patient to patient.
Monthly healthcare costs increase with dual coverage for a patient. For a dental practice, understanding and applying coordination of benefits can be cumbersome and it could also result in potential denials or increased administrative burdens.
Dual coverage implies dental insurance coverage through a primary and a secondary dental plan. While this does mean a patient would get covered twice, it enables a patient to enjoy a greater scope of coverage with lowered out-of-pocket expenses. When a patient has dual insurance coverage, the primary plan covers the larger part of the benefits while the secondary plan pays the pending amount.
