Are your employees aware of dual coverage and how it works? If not, they could be missing out on substantial savings on their dental care.
Dual coverage (or coordination of benefits), as the name implies, is when a person is covered under two dental plans. This doesn’t mean double coverage, however. Both plans won’t fully cover each approved procedure. In a dual coverage scenario, the primary carrier (or primary plan) will pay a larger portion of the benefits, while the secondary carrier (or secondary plan) pays a smaller amount.
Why would my employees have dual coverage?
There are several scenarios in which an employee may have dual coverage:
- An employee and his or her spouse both have employer-sponsored coverage
- An employee has two benefits-eligible jobs
That’s good to know! How do my employees know which is their primary carrier?
Your employees and their dependent children may be eligible for dual coverage. Which insurance carrier is the primary depends on several factors.
For employees, the primary carrier depends on whether the employee also has dental coverage through a spouse or domestic partner:
- If the employee does, the primary carrier is the one provided by his or her employer.
- If the employee doesn’t, but currently has two jobs that provide dental coverage, the primary carrier comes from whichever employer has provided coverage for the longest time. If the employee has coverage through a current and former employer, the current employer’s plan is primary.
For dependent children, the primary carrier depends on whether the child’s parents are married and live together.
- If they are (or have joint custody), the primary carrier is through the parent whose birthday falls earlier in the year. (If both parents have the same birthday, the primary carrier is the one that’s provided coverage for the longest time.)
- If they aren’t and don’t have joint custody, the primary carrier is though the parent who has legal custody of the child.
Is there anything else my employees should know about dual coverage?
Yes. For starters, dual coverage applies only to group plans, not individual plans. Group plans can coordinate benefits only with another group plan.
If one of the plans covering the claim is an individual dental plan, that plan will always pay coverage as primary. Individual plans can’t coordinate benefits with other individual plans, either. In that situation, all plans will pay as primary.
Also, if employees have dual coverage, they must inform their dental office of both plans before they receive treatment. (Failure to do so could be considered insurance fraud!) Once they do, we’ll coordinate the cost sharing with the employee’s other plan.
An important caveat is whether the employee’s secondary policy has a non-duplication of benefits clause. While this clause won’t negate their dual coverage, it means the coverage will provide less benefit than standard dual coverage would.
For example, if an employee has dual coverage in which the primary carrier covers 50% of a procedure and the secondary carrier covers 80%, then 100% of the cost of the procedure would be covered. However, if the secondary carrier has a non-duplication clause, then only that carrier’s 80% would be covered.
Employees should also be aware that they’re still responsible for amounts that exceed maximums, charges above the allowed amount if using an out-of-network provider and charges for non-covered services.
Finally, dual coverage involving an HMO-type plan such as DeltaCare® USA can be complicated. Employees can contact Delta Dental Customer Service for details if they have dual coverage involving two HMO-type plans or a PPO and HMO-type plan.
Does Delta Dental have dual coverage resources for my employees?
We offer several resources to help your employees navigate their dual coverage. Your benefits resources page offers materials that explain dual coverage, how it works, who’s covered and offers helpful contact information for questions. Employees can also refer to the dual coverage information available on the Delta Dental member site.
Dual coverage at first may seem confusing, but with some guidance and our resources, your employees can enjoy maximum saving with minimum hassle.
Note: This post was updated to specify that dual coverage applies only to group plans and doesn’t apply to individual plans.