Can I Get a Second Dental Insurance?

Dental care can involve significant costs, with a substantial portion paid out-of-pocket by patients. This financial burden often prompts questions about whether having more than one dental insurance plan can provide additional protection. Understanding how multiple plans interact is important for effective financial planning in oral health.

Eligibility for Multiple Dental Plans

It is generally permissible to be covered by more than one dental insurance plan, known as dual dental coverage. This often occurs when an individual has benefits through their own employer and is also covered as a dependent under a spouse’s plan, or when holding two jobs that each offer dental benefits. Individuals may also supplement an employer-provided plan with a privately purchased individual plan.

Understanding Coordination of Benefits

When an individual has two dental insurance plans, Coordination of Benefits (COB) determines how the plans work together to pay for services. COB ensures combined payments from both plans do not exceed the total cost of services, preventing over-insurance. This system establishes which plan pays first and how the secondary plan contributes.

Determining Primary and Secondary Plans

Determining which plan is primary and which is secondary is a structured process. Generally, the plan covering the individual as an employee or main policyholder is primary. For example, if an individual has coverage through their own employer and as a dependent on a spouse’s plan, their employer’s plan is typically primary. When a person has multiple employer-sponsored plans, the plan covering the individual for the longest duration is usually primary. For dependent children, the “birthday rule” often applies: the plan of the parent whose birthday occurs earlier in the calendar year is primary. A court decree specifying parental responsibility for dental expenses takes precedence over the birthday rule. Individual dental plans typically do not coordinate benefits with other individual plans; if one policy is an individual plan, it often pays primary.

Types of COB Rules

Different COB rules dictate how the secondary plan contributes. A “traditional” COB arrangement allows combined payments to cover up to 100% of covered expenses. A “non-duplication of benefits” clause may prevent secondary payment if the primary’s payment meets or exceeds what the secondary would have paid. “Maintenance of benefits” (MOB) reduces covered charges by the primary plan’s payment before applying the secondary plan’s deductible and coinsurance, often resulting in some out-of-pocket cost-sharing.

Key Considerations for Additional Coverage

Financial Elements

When considering a second dental insurance plan, examine several financial elements. Each plan, whether primary or secondary, has its own premium. Individuals should assess if the added premium is justified by potential out-of-pocket cost reduction. Each plan also has its own deductible, the amount paid before insurance begins to pay. Understanding how deductibles apply across two plans is important, as meeting multiple deductibles could diminish the financial advantage. Dental plans also include an annual maximum, the highest amount the plan will pay per year. While dual coverage does not double benefits, it can extend the total annual benefit available, especially if the primary plan has a lower annual maximum.

Plan Types

The type of dental plan significantly influences how coverage works. Preferred Provider Organizations (PPOs) offer a network of dentists with negotiated fees, and allow coverage for out-of-network providers at a higher cost. Dental Health Maintenance Organizations (DHMOs) usually involve lower premiums and fixed co-payments, but require choosing a primary dentist within a restricted network. Indemnity plans offer freedom to choose any dentist, reimbursing a percentage of charges, but may have higher premiums. Aligning the network restrictions and benefit structures of both plans can optimize coverage and access to preferred providers.

Waiting Periods

Waiting periods are common in dental insurance, especially for new coverage. These are specific timeframes that must pass before certain procedures are eligible for coverage. Preventive care, such as routine cleanings and exams, often has no waiting period and is covered immediately. Basic procedures like fillings or non-surgical extractions may have waiting periods ranging from three to six months. Major dental work, including crowns, bridges, or dentures, involves longer waiting periods, often six to twelve months, and sometimes up to 24 months. Some insurance companies may waive waiting periods if an individual can demonstrate continuous prior dental coverage.

Navigating Claims with Two Plans

When an individual has two dental insurance plans, claims submission follows a specific sequence. The claim must first be submitted to the primary insurance provider, allowing them to process it and determine payment responsibility. After the primary insurer processes the claim, they issue an Explanation of Benefits (EOB) document detailing services, the amount paid, and any remaining balance. The next step involves submitting the remaining balance, with a copy of the primary EOB, to the secondary insurance provider. The secondary insurer then reviews the claim and EOB to determine its contribution based on its policy terms and COB rules. This approach ensures both plans contribute appropriately to care costs.