Can I Have Two Dental Insurance Plans?
Navigate the possibilities and intricacies of holding multiple dental insurance plans. Understand how your benefits apply.
It is common for individuals to wonder if they can have more than one dental insurance plan to help manage oral healthcare expenses. This arrangement is generally permissible and frequently occurs due to various personal or employment circumstances. This article will explain how having multiple dental plans works and what policyholders should know about coordinating benefits.
Understanding Multiple Dental Plans
Having coverage under two different dental insurance plans, often referred to as dual dental coverage, is possible. This situation frequently arises when an individual is covered by their own employer’s dental plan and is also included as a dependent on a spouse’s or parent’s plan, or when holding two jobs, with each employer offering dental benefits. While it might seem like having two plans would double the benefits, this is not the case; dental insurance policies include provisions to prevent individuals from receiving duplicate payments for the same service. Instead, dual coverage aims to help reduce out-of-pocket costs by allowing the plans to share the expense of dental procedures. This setup can be particularly advantageous for more extensive treatments, helping to bridge gaps in coverage that a single plan might leave.
The Role of Coordination of Benefits
When an individual is covered by more than one dental plan, insurance companies utilize a process called Coordination of Benefits (COB). COB is an industry standard designed to determine the order in which plans pay for services and to prevent over-insurance or the duplication of benefits. This process ensures that the total amount paid by all insurers for a dental procedure does not exceed the total cost charged by the dentist. COB establishes a clear framework for how multiple insurance policies interact, ensuring that each plan contributes appropriately without paying more than its share. It is worth noting that COB rules primarily apply to group (employer-sponsored) plans, meaning individual policies may not always coordinate benefits.
Designating Primary and Secondary Coverage
Under Coordination of Benefits, one dental plan is designated as “primary” and the other as “secondary.” The primary plan is responsible for paying its benefits first, and the secondary plan then considers any remaining balance. Several common rules determine which plan takes precedence.
For an individual covered by their own employer’s plan and also as a dependent on a spouse’s plan, their own employer-sponsored plan is typically the primary coverage. If a person has two jobs and is enrolled in benefits at both, the plan they enrolled in first often becomes the primary insurance.
For dependent children covered by both parents’ dental plans, the “Birthday Rule” is commonly applied. This rule designates the plan of the parent whose birthday falls earlier in the calendar year as primary, regardless of the birth year. For example, if one parent’s birthday is in March and the other’s is in July, the March birthday parent’s plan would be primary.
Additionally, active employee coverage is generally primary over retiree coverage, and a patient’s own plan is usually primary over one where they are a dependent.
Navigating Claims and Costs
When a patient has dual dental coverage, the claims process involves both the primary and secondary plans. The dental office typically submits the claim to the primary insurer first. Once the primary plan processes the claim and pays its portion, an Explanation of Benefits (EOB) is issued, detailing what was covered and any remaining balance. This EOB is then submitted to the secondary plan, which reviews the remaining amount and may cover additional costs.
While dual coverage can significantly reduce out-of-pocket expenses, it rarely results in 100% coverage of a service. Deductibles, co-insurance, and annual maximums still apply to each plan, and the secondary plan will only pay up to what it would have paid if it were the primary plan. Policyholders should communicate clearly with their dental provider about both plans to ensure claims are processed correctly and to understand their potential financial responsibility.