Valentine’s Day is a time to rejoice about all the love in your life. Whether you spend it with your significant other, family, or friends, love is certainly in the air every February 14th. Many of us share more than just quality time and memories with our significant other – sometimes we share benefits. Like dental benefits, to be specific. If you or someone in your family has more than one provider of dental benefits, coordination of benefits, or a COB, may be needed.
Insurance terms and acronyms can be intimidating or confusing. Like “COB.” This term is one you should get to know because it may help you or your family out one day! Learn why coordination of benefits takes place and why it’s an added benefit of having dental benefits.
Why Does Coordination of Benefits Take Place?
The coordination of benefits occurs when an individual is part of more than one dental benefits plan. If your dental plans include a COB provision, the providers allow your dental costs to be divided between more than one dental plan.
So, if you only have one source of dental coverage, you don’t have to worry about coordinating benefits right now! If you get married, change jobs, or gain another source of dental coverage in the future, be sure you know how this works. Coordination of benefits is often mandated by state laws and regulations.
If your dental plans include a COB provision, you and your benefits providers only pay what each of you is individually responsible for after a primary and secondary provider is determined. It doesn’t mean that a service is covered twice by two plans. It means that you have more layers of coverage to apply to dental procedures. Instead of being split two ways – between you and your single dental provider – the share of the cost burden is divided in three or four ways.
The general rule of thumb is that the plan that covers you as an enrollee is designated as your primary plan. The plan that covers you as a dependent becomes your secondary plan. For children, who aren’t policyholders (yet), parents’ birth dates come into consideration – only the day and month, not the year. The parent whose date of birth is first in the year is generally designated as the holder of the primary policy. So, the policy provided by a parent born July 15th would be primary if the other parent was born September 22nd. A divorce agreement or court ruling can overrule this.
What Does Coordination of Benefits Look Like?
Let’s say you visit the dentist to fill a cavity. The office will send the bill to your primary dental plan. If that plan covers fillings at 80%, and it was a $100 filling, the plan will pay your dentist $80.
Typically, with a single dental benefits provider, you would owe $20. But, since you have more than one dental plan, you can send the dentist’s bill to your secondary plan! Then, the second dental benefits provider will pay their portion of the balance on your dental claim.
For that same $100 filling, if the second plan covers fillings at 80%, it would have paid your dentist $80 as the primary source of coverage. However, since you had another plan as your primary, the secondary plan pays up to their original contribution! So, the second company will pay the remaining $20 since it’s less than what their primary contribution would have been.
If you’re lucky enough to share your life with someone, you could benefit from sharing your dental benefits, too! You may even end up saving some money!
To find out if your plan has COB coverage, sign in and review your plan details.
Editor’s Note: Content updated February 2019.