Dental Benefits Terminology: Coordination of Benefits
If you are enrolled in more than one dental plan—a plan through your employer and another plan through your spouse's employer, for example—the two plans may work together to pay your dental claims. This process is called coordination of benefits, or COB. COB helps members with dual coverage receive the maximum benefits available while ensuring payment from all plans does not exceed 100% of the total charges for a covered service.
Below are a few of the most common questions about COB. This information can help you better understand how the COB process works in general; however, it's important to review each plan's specific rules, which are usually found in your evidence of coverage. Plans can have different types of COBs, and in some cases, you may not be able to collect benefits from both plans.
Which Plan is Considered My Primary Plan?
Many dental plans follow the rules established by state law to determine which plan pays first. In general, the plan you are enrolled in through your employer is considered your primary plan, and the plan through your spouse’s employer is considered secondary. If a plan does not coordinate benefits, it is considered the primary plan. For covered dependents, the birthday rule usually applies—the parent's birthday first in the calendar year is considered the primary carrier. If a divorce has occurred, the plan follows the divorce decree.
How Does Coordination of Benefits Work?
Typically, the primary plan must first pay benefits without regard to the possibility that another plan may cover some expenses. After the primary plan has paid the benefited amount of a claim, the secondary plan considers eligible benefits for any remaining balance without exceeding the dentist's total charge. Any calculation or adjustment of benefit is usually done by the secondary carrier after receiving documentation of the primary carrier's payment.
Do I Receive Double the Benefits by Enrolling in Two Dental Plans?
No. Enrolling in two dental plans doesn't mean you will receive duplicate benefits. Since both plans review each claim, the COB process manages the payments between plans so that you receive the maximum benefit available to you for covered services.
Enrolling in more than one dental plan can help reduce out-of-pocket expenses for your dental care. By carefully reviewing and understanding each plan's COB rules, you can make the most of your dual coverage.