Understanding Coordination of Benefits for patients with Dual Coverage

Coordination of benefits (COB) is the process insurance companies follow to ensure that the combined benefits from all group dental plans do not exceed 100 percent of the dentist’s fee. There are different types of coordination of benefits policies so it is very important when verifying benefits to confirm whether or not your patient’s policy coordinates benefits. Below you will find a list with descriptions included for some of the more common types of COB policies. 

Traditional: If a plan has a traditional COB policy, the secondary plan shares the burden of payment with the primary plan and pays up to the 100% of the fee charged. This is the rare scenario where payments from both plans cover the total cost of treatment.

Traditional: If a plan has a traditional COB policy, the secondary plan shares the burden of payment with the primary plan and pays up to the 100% of the fee charged. This is the rare scenario where payments from both plans cover the total cost of treatment.

Maintenance of Benefits: Under this type of COB policy, the secondary plan reduces the covered charges by the amount the primary plan paid and then applies the plan deductible and eligible co-insurance amounts. In this type of situation, the secondary plan pays less than what it would have paid in a traditional COB arrangement and the patient is usually left with an out of pocket expense.  

Non-duplication of benefits: If the policy has a non-duplication clause, the secondary plan will pay only the difference between what the primary plan pays and what the secondary plan would have paid if it had been the primary carrier. For example, if the primary carrier has an 80% benefit for a service and the secondary also has an 80% benefit, the secondary carrier will not pay anything additional. In the case where the primary carrier has a 50% benefit for a service that secondary has an 80% benefit for, then the secondary carrier will reduce its benefit to 30% to make up the difference.