Can I Have Multiple Dental Insurance Policies?

Many individuals wonder if having more than one dental insurance policy is permissible or beneficial. Understanding how multiple dental plans interact is important for managing healthcare expenses effectively.

Understanding Multiple Dental Policies

It is possible to have coverage under more than one dental insurance policy, a situation often called dual dental coverage. This commonly occurs when an individual has access to dental benefits through two employers, or is covered by their own plan and as a dependent on a spouse’s or parent’s plan. Dual coverage means plans work together to cover costs, not that benefits simply double.

Coordination of Benefits (COB) governs how multiple dental plans interact. COB rules determine which plan pays first and prevent overpayment. The objective is to ensure combined payments from all plans do not exceed the total cost of dental services. Group plans are typically required to coordinate benefits, while individual plans generally do not.

How Claims Are Processed

When an individual has two dental insurance policies, COB rules determine the order of payment, designating one as the primary insurer and the other as secondary. The primary plan covers the individual as an employee or main policyholder. If a person has two jobs with dental coverage, the plan that has covered the individual for the longest time is considered primary.

For dependent children covered by both parents’ dental plans, the “birthday rule” applies to determine the primary insurer. Under this rule, the plan of the parent whose birthday occurs earlier in the calendar year is designated as primary, regardless of the birth year. If a court order specifies which parent is responsible for the child’s dental expenses, that order may override the birthday rule.

Once the primary plan is identified, claims are submitted first. After the primary plan processes the claim and pays its portion, an Explanation of Benefits (EOB) is issued, detailing coverage and remaining costs. This EOB is then submitted to the secondary insurer, which reviews the remaining balance and applies its own benefits. The secondary plan will not process a claim until it receives the EOB from the primary insurer.

Two common COB terms that affect how the secondary plan pays are “non-duplication of benefits” and “carve-out.” Non-duplication of benefits means that if the primary plan paid as much or more than the secondary plan would have paid had it been primary, the secondary plan may not pay anything further. Carve-out is a method where the secondary plan calculates its normal benefit and then reduces that amount by what the primary plan paid. The combined payments from both plans will generally not exceed 100% of the allowed charge for the services.

Evaluating Multiple Policy Scenarios

Having multiple dental insurance policies can offer advantages, particularly for individuals anticipating extensive dental work or those with significant ongoing oral health needs. Dual coverage can help reduce out-of-pocket expenses by covering a larger portion of treatment costs that a single plan might not fully address. It can also be beneficial if the annual maximum of one plan is insufficient for planned procedures, allowing the secondary plan to contribute after the primary plan’s limits are met.

Owning multiple policies also comes with considerations. Individuals will pay premiums for each plan, and the combined cost of these premiums might outweigh the additional benefits received, especially if dental needs are minimal. While dual coverage can reduce patient responsibility, it does not guarantee 100% coverage of all costs, and there may still be copayments or deductibles. It is advisable to compare the annual maximums, deductibles, waiting periods, and specific COB rules of each policy to determine if a second plan provides a tangible financial advantage.