Dual Coverage: Coverage Under More Than One Dental Plan[1]

It’s not uncommon for people to have coverage under two separate dental plans. For example, your dependents may be signed up for dental benefits through both your employer and your spouse’s employer. Whether it’s you or your dependents, anyone with coverage under two separate dental plans has what is referred to as “dual coverage.”

How It Works

The way insurance companies work together when a person has dual coverage is called “Coordination of Benefits.” First, the dentist bills the primary insurance carrier. The primary carrier pays its portion, and the remainder of the bill is sent to the secondary insurance carrier. In some cases, the secondary carrier may cover the rest of the bill, reducing your out-of-pocket costs. Dual coverage does not mean double benefits—if your plan covers two cleanings per year, for instance, dual coverage won’t cover four cleanings instead.

Determining Which Plan is Primary

The insurance plan that is billed first is called the primary plan, and the insurance plan that is billed after the primary insurance has paid its portion is called the secondary plan. Which plan is primary depends on your individual situation.

• For yourself: If you have a plan through your employer, that is typically your primary plan. If you also have coverage through a spouse, that plan will be secondary.
• For yourself, if you have two jobs: If you have two jobs, and dental insurance through both employers, the primary plan is usually the one that has provided coverage the longest.
• For your children: If you have children with dual coverage, the parent whose birthday falls first in the calendar year will have the primary plan. For example, if your birthday is August 9, and the other parent’s birthday is July 21, the other parent’s plan would be the primary. Year of birth is not a factor.

When Both Plans Are Delta Dental Plans

Many employers use Delta Dental, so it’s possible that Delta Dental would provide both dual coverage plans, even if both parents don’t work for the same company. If this is the case, don’t worry—dual coverage works the same way if both plans are through Delta Dental.