What Is Primary And Secondary Dental Insurance Rules

Whether it is possible to have two dental insurance plans simultaneously is one of the many strains among your patients and practice. Whereas, there are other concerns such as the policy’s benefits and limitations, and several types with different conditions associated. The answer may be positive or only once you understand primary and secondary dental insurance rules and conditions associated with both dental coverage plans. For instance, entertaining the benefits of having two dental insurance plans may cost your patients to pay a part of their insurance plans, plus they may compromise on two deductibles and two monthly premiums. Having complete knowledge of the duality of dental plans will only help your practice bill services accurately, get paid quickly, and help patients get the best of both worlds. Follow this guide to get a good knowledge of the different features and conditions associated with the pros and cons of having two dental insurances to make the decision easy for aspirants. Let’s begin!

What Is Dual Dental Coverage And How Does It Work?

Dual dental coverage or supplemental dental coverage refers to the situation when an individual is covered under two different dental insurance plans: Primary dental insurance, often acquired through employment and a secondary dental plan that your patients can obtain individually. The dual policy allows the applicants to enjoy both benefits and completely enhance coverage of dental treatment costs. However, it isn’t guaranteed that having two insurance will double the coverage, but insurance carriers determine the plan’s coverage as per the “certain coordination of benefits” (COB) to clarify which plan pays first, speed up claim processing, or eliminate redundant benefits. Here is a breakdown of several COB types:
Traditional— It indicates that the recipient may receive up to 100% of the costs of dual insurance or primary and secondary dental policies through traditional COB.
Maintenance of benefits— MOB includes maintaining plan deductibles and coinsurance requirements after lessening covered dues by the amount that the primary plan offers. Consequently, the beneficiary holds some cost-sharing, and the plan pays less than expected in a traditional COB structure.
Carve out - This type measures the amount that would normally be paid in plan benefits and deducts it from the amount that the primary plan will pay.
Non Duplication COB - This type of coordination of benefits states that the secondary carrier will obtain no charges if the primary carrier makes payments equal to or more than what the secondary insurance provider would have paid as a primary carrier. Many self-funded dental plans generally apply the rule of non-duplication (non-duplication of benefits clause). On the other hand, a self-funded dental plan means the plan sponsor will hold the risk of utilization.
The Employment Retirement Income Security Act (ERISA) governs self-funded plans free from state insurance requirements. The act requires dental offices and practices to be aware that only some patients will have a dental plan covered by the state's COB legislation.

Primary Dental Insurance Coverage: The Key Features

• Primary dental coverage is the initial layer of benefits available to an individual.
• The primary plan covers many treatment expenses that the patient induces.
• Patients may be responsible for paying a copayment or deductible before the insurance company begins cost coverage of dental services.
• Primary coverage, offered by an individual’s employer as part of a benefits package, covers preventive dental care, including routine cleanings, check-ups, and X-rays.
• Primary coverage offers a maximum yearly limit on the benefits that can be received.
• The plan may extend to cover more complex dental procedures like fillings, crowns, and root canals.
• The level of coverage for complex procedures varies as per the specific insurance plan.
• Some primary plans cover only a portion of the expenses for these services, while patients may need to pay the remaining amount out of their pocket.

Secondary Dental Insurance Coverage: Key Features

• Secondary insurance coverage complements the primary dental insurance plan with additional benefits for treatments not covered by the primary plan.
• Patients use the plan when treatment or dental procedures exceed the maximum coverage limit of their primary insurance.
• Secondary dental coverage does not replace primary dental insurance but supplements it by covering costs that are not part of the primary dental plan.
• Not all insurance plans offer secondary coverage. However, patients are eligible for coverage when their primary plan allows it.
• Individuals must have a primary dental insurance plan supporting secondary coverage for having a secondary dental insurance.
• When patients inquire about coverage options, your dental practice must consider the conditions for treatment acceptance and costs. Hence, understanding both primary and secondary dental insurance rules is crucial.

Primary VS Secondary Dental Insurance Rules

In order to manage your dental billing and reimbursement, understanding the difference between primary and secondary dental insurance rules is an essential part of your practice. Here is a line of differences between both policies regarding services covered, coverage limits, co-payments, etc.

Insurance Rules:	Primary Dental Insurance	Secondary Dental Insurance
Coverage Limits	Yearly maximum coverage limit Patient’s responsibility for cost beyond the limit	Covers costs surpassing the primary plan’s limit May have its coverage limit
Covered Services	Covers preventive care, routine cleanings, check-ups, and X-rays May cover complex procedures like crowns, fillings, and root canals Coverage levels vary as per the insurance plan	Covers remaining costs not handled by the primary plan
Copayments deductibles	Patient co-payment and deductible are required before coverage begins	Copayments and deductibles may be required according to the specific plan
Premiums	Paid by individual, depending on the plan type.	Often, individuals pay with potentially separate premium costs.
Coordination of Benefits	Important in primary dental insurance Insurance companies determine coverage for a specific dental plan Primary insurance pays first	Important in secondary dental insurance Insurance providers determine coverage for a specific plan The secondary plan pays for remaining costs up to its limit
Network of Providers	Network of providers required for treatment coverage	May have its network or allow the use of any licensed dentists by the patient

Pros And Cons Of Having Two Dental Insurances

The benefits of having dual coverage dental insurance are that they help the patients fill the lack of primary plan coverage that can arise, especially when an individual’s primary policies reach the limit, or your patients may not take the coverage for additional or desired treatments. However, certain risks are associated with having dual coverage in dental insurance. The following table will differentiate the policy’s features to let you decide carefully on secondary dental coverage.

Pros Of Having Two Dental Insurance

Cons Of Having Two Dental Insurance

Having both primary and secondary dental insurance expands coverage, to support patients while taking a broader range of dental services. With dual coverage, your patients may experience less out-of-pocket costs, especially for unexpected or additional dental procedures. Your patients’ primary plan covers preventive care and major dental work coverage. The coordination between the two plans enhances coverage for special treatments such as primary plan covers first whereas, the secondary dental insurance pays for the remaining dues. Initial costs of paying double premiums may be higher but your patients can have substantial long-term savings. Having primary dental insurance requires a specific network, whereas, a secondary plan is more flexible for patients to choose from numerous dentists.

Having dual dental insurance means paying double premiums to increase monthly healthcare costs. The coordination of benefits process can be complex and can lead to potential denials and administrative burden while proceeding with coverage details. Some services may be repeatedly covered, leading to overlapping benefits that don’t increase overall value. Secondary plans lead to higher deductible accumulation. Proper understanding of both primary and secondary dental insurance rules may be confusing, leading to complication in the dental billing process. If any of your patient’s dental policy has a certain waiting period for several services, they may need to wait before benefiting from full coverage for those services.

FAQs:

Can you use primary and secondary dental insurance?

Yes, it is worth having primary and secondary dental insurance plans or dual coverage for your patients. However, your dental practice must determine which plan is best for your patients to ensure cumulative coverage doesn’t exceed 100% of the total payment.

Is it illegal to have two dental insurances?

It isn’t illegal to have two dental insurance plans, as it is a common practice among your patients to opt for dual coverage and enhance their benefits to reduce out-of-pocket charges. However, understanding the terms and conditions is essential before deciding to avoid potential risks or legal issues.

Can you use two dental insurances for braces?

Many dental insurance providers also offer dual coverage for braces and other Orthodontic treatments. Moreover, your patients can get help by coordinating benefits between primary and secondary dental plans and reducing their out-of-pocket costs. However, the point of consideration is that you must contact both plans’ providers to understand specific coverage details for orthodontic care procedures.

Offering Simple Solutions For Your Dental Practice To Bill Accurately And Get Paid Quickly With MedsDental Billing

MedsDental Billing company provides your practice with the best of both worlds: A complete guide to various dental insurance types and associated terms and quality solutions for your practice billing. Connect with us whenever you realize the perils of communicating with insurance providers or in quality dental care delivery to patients. We have many solutions to handle your jobs efficiently, reimburse you for common or specific dental treatments, and offer the complete dental care your patients need.