ET's Info-Stew

Do you know what a "non-duplication of benefits" clause is? If not and you think you have double coverage on your benefits (medical, dental, vision, etc.), you better learn. I learned the hard way. You can learn the easy way: http://findarticles.com/p/articles/mi_m0903/is_n10_v11/ai_14244221.

Jenny and I received a bill from her dentist for $935 for Jenny's dental work. On the bottom was a nice note from an administrative person there saying that my benefits did not cover any expenses from her dental visits because we had a "non-duplication of benefits" (NDB) clause. So say the total expenses were $2,000. Her benefits would cover $1,065 of the work, and mine would cover $835 of the work. Under my previous understanding of double coverage, I would expect the amount we owe is $2,000 - ($1,065 + $835) = $100. Heck, if my insurance were a little better, we might not need to pay a dime.

We both are under Delta Dental policies with NDB clauses. What that means is, her coverage would pay $1,035, since her coverage is her primary coverage. With the NDB, since my coverage (her secondary coverage) is less than hers, she gets no benefit from my coverage (this is an oversimplification, because the comparison of benefits is actually done on a per-item basis). Now, if it were me getting the work done, my coverage would pay $835. Then her coverage would pay $200 ($1,065 - $835), and we would still end up having to pay the difference, which is $935.

Since my coverage is worse than hers across the board, my coverage is completely useless. However, since I don't pay for my coverage at all, at least that doesn't cost me extra. It does cost Sandia, though, so I may cancel it.

So, if you were putting off getting an expensive procedure done until you had double coverage, you better understand your policy's non-duplication of benefits stance. If you are both paying for coverage, and one is better than the other across the board, the one with the worse benefits is effectively throwing away money at useless coverage.