Dual and Tertiary Insurance
What happens if you or a family member is covered by more than one dental plan? You don’t get “double” the cleanings and coverage, but it can mean additional out-of-pocket savings on dental treatment. Here’s more information on what dual and tertiary coverage means for you.
How Dual Coverage Works
“Dual coverage” refers to when your dental treatment is covered by more than one dental benefits plan. Delta Dental of Kansas works with the other insurance company to coordinate your benefits (COB) — the guidelines insurance companies follow to determine how much each dental plan you are covered by will pay. Typically, the plan that covers you as an enrollee is the primary plan and the plan covering you as a dependent would be the secondary plan. For children, the primary insurance is determined by the coverage of the parent whose birthday (month and year) comes first.
What are the advantages?
Depending on the specific COB rules each carrier has, one advantage of dual coverage could come in the form of lower out of pocket costs for dental care. The secondary coverage could cover a portion of a leftover balance remaining after primary insurance has paid its benefit for a service. Savings depends on whether your carrier has a non-duplication of benefits clause, meaning that the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows for that dentist.
For example, if your dentist charges $100 for a filling and your primary insurance covers fillings at 90 percent, the primary plan would pay the dentist $90.
Typically, you’d receive a bill for $10, but your secondary insurance covers fillings at 80 percent of the cost.
The secondary insurance would pay 80 percent, or $8 of the remaining $10 to the dentist and you’d be responsible for the remaining $2, before any applicable deductibles.
What are the disadvantages?
Problems can arise with being covered by more than one dental plan when a claim is processed. It’s critical to let your dental office know that you have dual coverage. Knowing which carrier is primary, secondary, or tertiary ensures that claims are processed correctly and in a timely manner.