Can I Have Double Dental Insurance Plans?

Dental insurance helps manage oral healthcare costs, from routine check-ups to extensive procedures. Many individuals wonder about having more than one plan. This article clarifies dual dental coverage, explaining how plans interact and claims are processed.

Having Multiple Dental Plans

It is permissible to have multiple dental insurance plans, a situation often called dual dental coverage. This scenario typically arises when an individual has coverage through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Another frequent occurrence is combining an employer-provided plan with a privately purchased dental policy. Having more than one plan does not mean you will receive double benefits or that all services will be paid for twice. Instead, the plans work together to coordinate benefits, aiming to reduce your out-of-pocket costs for covered services.

Understanding Coordination of Benefits

When an individual has more than one dental plan, a system called Coordination of Benefits (COB) dictates how these plans work together to pay for services. COB rules prevent overpayment and ensure that total reimbursement from all plans does not exceed the total cost of the dental service. One plan is designated as “primary,” paying its benefits first, and the other plan becomes “secondary,” covering remaining eligible costs. Several rules determine which plan is primary. For dependent children, the “birthday rule” is commonly applied, making the plan of the parent whose birthday falls earlier in the calendar year the primary one. If a person has coverage through their own employer and also through a spouse’s plan, their own employer-sponsored plan is typically primary. For individuals with two jobs offering dental benefits, the plan that has covered the patient the longest often serves as the primary plan. Some plans include a “non-duplication of benefits” clause, meaning the secondary plan may not pay if the primary plan’s payment met or exceeded what the secondary plan would have paid as primary.

Claim Processing with Multiple Plans

When a patient has multiple dental plans, the process for submitting and settling claims involves a specific sequence. Initially, the dental office submits the claim to the primary insurance provider. The primary insurer processes the claim and pays its portion of the covered services, based on the patient’s benefits and the plan’s provisions. After the primary plan has paid, an Explanation of Benefits (EOB) is issued, detailing what was covered and what remains. This EOB is then submitted to the secondary insurer, along with the original claim, for consideration of the remaining balance. The secondary plan assesses the claim and may cover additional costs, further reducing out-of-pocket expenses, though combined payment from both plans will not exceed the total allowable charge.