What Is Secondary Dental Insurance and How Does It Work?

Dental insurance helps manage the costs of oral health care. Many individuals rely on a single dental plan for preventive care, basic procedures, and sometimes major services. However, one plan might not fully address all dental needs or costs, leading some to explore additional coverage. This article explains what secondary dental insurance is and how it functions alongside a primary policy.

Defining Secondary Dental Insurance

Secondary dental insurance is a supplementary plan that provides an additional layer of coverage beyond a primary dental insurance policy. It complements a primary plan, assisting with costs the primary plan does not fully cover or when its annual limits are reached. This type of coverage is also known as dual dental coverage or supplemental dental insurance. For instance, if a primary plan covers 80% of a procedure, the secondary plan might help pay for the remaining 20% or a portion thereof, depending on its terms.

A secondary plan reduces out-of-pocket expenses for dental treatments. It can be beneficial for individuals or families with extensive dental needs or those anticipating costly procedures. While a primary plan typically has annual maximums, often ranging from $1,000 to $1,500, a secondary plan can extend financial protection once that limit is met.

The Coordination of Benefits Process

When an individual holds both primary and secondary dental insurance, the interaction between these plans is governed by Coordination of Benefits (COB). COB rules determine which plan pays first and how much each plan contributes to a dental claim, ensuring combined payments do not exceed the total cost of the service. The primary plan is always billed first, processing the claim as if no other insurance exists.

Once the primary plan processes the claim and issues payment, an Explanation of Benefits (EOB) document is generated. This EOB details the services, the amount paid by the primary insurer, and any remaining balance. The secondary plan then receives this EOB and considers the outstanding amount. It will pay benefits according to its own coverage guidelines, often covering a portion of the remaining balance up to its policy limits, after any deductibles or co-insurance are applied.

A common COB rule is the “non-duplication of benefits” provision, meaning the secondary plan will not pay more than it would have if it had been the primary insurer. For example, if both plans cover a treatment at 80%, and the primary plan pays 80%, a secondary plan with a non-duplication clause might pay nothing further. Other COB methods, such as “traditional” or “maintenance of benefits,” may allow for up to 100% of expenses to be covered by the combination of plans. Identifying the primary plan typically follows specific rules: if an individual is the subscriber on both plans, the one with the earliest effective date is usually primary. For children covered by both parents’ plans, the “birthday rule” often applies, making the plan of the parent whose birthday comes first in the calendar year the primary one.

Obtaining Secondary Dental Coverage

Secondary dental coverage can be acquired through various avenues. A common scenario involves employer-sponsored plans, where an individual might have coverage through their own job and also be covered as a dependent under a spouse’s employer-provided plan. It is also possible for individuals holding two jobs to receive dental benefits from both employers, leading to dual coverage.

Beyond employer-based options, individuals can directly purchase a secondary dental plan from insurance providers. Some governmental programs, such as Medicare or Medicaid, may also offer supplemental dental plans for eligible beneficiaries. When considering a secondary plan, evaluate factors like premiums, the network of dentists available, and the specific types of procedures covered, to ensure the plan aligns with your dental care needs.