Can I Have Multiple Dental Insurance Policies?

Dental insurance helps cover a portion of oral health care costs. These plans typically categorize services into preventive care, such as routine check-ups and cleanings, basic procedures like fillings and extractions, and major procedures, including crowns and root canals. Many individuals have access to more than one plan, perhaps through two different employers or by combining an employer-sponsored plan with an individual policy. This raises questions about the permissibility and practical implications of holding multiple dental insurance policies.

Possibility of Multiple Policies

Individuals can generally have more than one dental insurance policy simultaneously. This dual dental coverage is common in several scenarios. For instance, an individual might have coverage through their employer and also be covered as a dependent under a spouse’s plan. Another common scenario involves individuals holding two jobs, each providing separate dental benefits. Additionally, some purchase a supplemental individual dental plan to augment existing employer coverage, and understanding how these plans interact to cover dental expenses is essential.

Coordination of Benefits

When an individual has multiple dental insurance policies, Coordination of Benefits (COB) is the process by which these plans work together to pay for claims. COB rules determine which plan pays first, known as the primary insurer, and which plan pays second, referred to as the secondary insurer. The primary plan processes and pays its portion of the claim first, and then the secondary plan considers the remaining balance. For an individual, their employer’s plan is typically primary over a plan where they are a dependent. If an individual has two employer plans, the plan that has covered them for the longest duration is usually designated as primary.

For dependent children, the “birthday rule” often determines the primary plan: the parent whose birthday falls earlier in the calendar year. However, court orders regarding child custody can override the birthday rule. COB prevents overpayment, ensuring combined payments do not exceed 100% of the dental service cost. Some secondary plans include a “non-duplication of benefits” clause, meaning they will not pay if the primary plan has already paid as much or more than the secondary plan would have paid on its own; other plans might employ “maintenance of benefits,” where the secondary plan reduces its payment based on what the primary plan paid, potentially leaving the policyholder with some out-of-pocket costs. It is important to inform both insurance companies about other policies to facilitate accurate claims processing.

Factors When Considering Multiple Policies

Consider the financial implications when evaluating multiple dental insurance policies. Weigh the total cost of premiums against potential out-of-pocket expense reduction. While extensive procedures, such as root canals, crowns, or orthodontics, might see significant cost reduction through dual coverage, the combined premiums might exceed the savings for routine or less frequent dental needs.

Managing claims with two insurers can introduce administrative complexities. This involves more paperwork, increased communication, and a need to understand two distinct plan structures and their COB rules. While multiple policies might appear to offer double coverage, COB rules generally limit the total payout to 100% of the allowable charge, meaning benefits do not simply add up. However, a secondary policy can fill coverage gaps, such as providing benefits for orthodontics not covered by the primary plan, or extend total coverage by utilizing separate annual maximums. Review the specific COB clauses within each policy and, if possible, consult with dental providers or insurance representatives to understand how the plans will apply to anticipated treatments.