Dentovio public answer
dental coordination of benefits
When a patient has two dental plans, the primary plan pays first under its own terms, as if no other coverage existed.
Sourced answer
When a patient has two dental plans, the primary plan pays first under its own terms, as if no other coverage existed. Under traditional coordination of benefits, the secondary then pays the balance of the allowed amount the primary left unpaid — up to what the secondary would have paid on its own — which often brings the patient share of the allowed charge to $0. Under a non-duplication clause, the secondary pays only the amount by which its own benefit exceeds the primary's payment, which is frequently $0 when both plans cover the service at the same percentage. Which plan is primary comes from the state's adopted version of the NAIC Coordination of Benefits Model Regulation; the non-duplication method itself is a plan-document term the model regulation does not define, so the plan document controls it — and a self-funded employer plan is generally governed by ERISA rather than the state's COB rules, though not categorically: a self-funded governmental or church plan is not an ERISA plan at all.
- Cluster
- Practice operations
- Last verified
- 2026-08-30
- Reviewer
- None — owner-published
Dentovio is an independent publisher, not an insurance carrier, benefits administrator, the ADA, or any government agency. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist or attorney. These pages describe how the two most common coordination-of-benefits methods and the birthday rule work in general terms; the plan documents and each state's adopted COB rules control the actual order and amounts, and a self-funded employer plan is generally governed by ERISA rather than those state rules. Educational reference only — not legal, benefits, or billing advice; confirm the order of benefits and the secondary plan's coordination method with each carrier before quoting a patient.
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Query patterns
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Source citations
- NAIC-MDL-120 NAIC Coordination of Benefits Model Regulation (MDL-120) (content.naic.org)
- NAIC-MODEL-LAWS NAIC model laws index (content.naic.org)
- USC-29-1144 29 U.S.C. § 1144 — ERISA preemption of state law (uscode.house.gov)
- ADA-COB-GUIDANCE ADA guidance on coordination of benefits (ada.org)