Dual Dental Insurance: Primary and Secondary Dental Insurance Rules

What is primary dental insurance?

Primary dental insurance is a policyholder’s main plan that helps cover treatments and procedures. Based on the plan’s specifics, you may have to pay a co-payment or deductible before insurance kicks in. The level of coverage for specific procedures varies by plan, and you may have coverage limits that dictate how much your insurer will cover before you have to pay more out of pocket.

Primary dental insurance policies typically cover:

• Preventative care: This can include basic preventative management.
• Basic services: Procedures like dental fillings and simple extractions fall under this category.
• Major services: More surgical, complex procedures and oral surgery are categorized as major services.

Aflac offers dental insurance for individuals with a variety of coverage levels, to fit most oral care needs. Speak with an Aflac agent to learn more about what our primary dental plans cover.

What is secondary dental insurance?

Secondary dental insurance provides additional benefits for treatments that are not covered by a primary dental plan. It’s often used when a patient requires a medically necessary treatment that exceeds their primary insurance plan’s coverage limit. Not all insurance plans allow secondary coverage, so you must verify yours does before applying for a secondary plan.

Aflac supplemental dental insurance is a type of secondary dental insurance that provides cash benefits for expenses not covered by primary insurance. It’s not intended to replace a primary plan. Instead, it supplements the primary plan by helping cover costs that are not typically covered due to reasons like coverage limits or procedures deemed non-medically necessary.

How dual dental insurance coverage works

When you have dual coverage, your plan will have contractual language that explains how your COB works between the two plans. It’s important to note that only group (employer) plans are required to coordinate — individual plans do not coordinate. Additionally, state laws and regulations play a significant role in how insurance benefit coordination works, so it’s important to check plan specifics with your insurer directly.

Generally, a secondary policy will not accept a claim until the primary policy has fulfilled the available benefits. The secondary policy will then request an explanation of benefits (EOB) from the primary insurer to verify that the combined amount paid by both plans does not exceed what the dentist charges, avoiding a duplicate charge.¹ For instance, let’s say you need a root canal, which is considered a major service:

• Your primary dental insurance has a $1,500 annual coverage limit and pays 50% of major services.
• Your dentist charges $2,000 for a root canal, so your primary insurance plan covers $1,000.
• You owe the remaining $1,000, but your secondary insurance plan helps cover the remaining amount.