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Yes – you can buy an individual plan in addition to your work plan. This situation is referred to as dual coverage. Dual coverage is when multiple dental plans cover a single patient's dental treatment. This does not “double” your coverage but can significantly reduce your out of pocket expenses.
With dual coverage, there will be a primary plan and secondary plan. If an enrollee has a plan through their employer, that plan will be primary. A secondary plan could be through a spouse's plan.
Another scenario could be an enrollee has two plans: one through their employer and an additionally purchased individual dental plan. The plan through their employer is primary and the additional individual plan is secondary. The secondary plan will act as a supplement to the primary plan.
Coordination of benefits guarantees that the plans do not pay over 100 percent of the dental fee.
What is the process for dual coverage claims?
The dentist will send the primary carrier the dentist's fee, the primary carrier will pay their percentage of the fee and send the invoice back to the dentist, then the dentist sends the claim to the secondary carrier and they pay their percentage of the invoice.
For example, a patient's primary plan through their employer pays for 50 percent of a dental treatment and the patient purchased an additional plan that also pays for 50 percent of a dental treatment. If the patient has a dental treatment that costs $640.00, the primary plan would pay $320.00 and the secondary plan would pay their 50 percent, $320.00, leaving the patient's out-of-pocket cost to be $0.00. There are also instances where the primary plan does not cover a particular dental service (i.e. dental implants) and the secondary plan will still pay its covered amount.
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