Can I Have Two Dental Insurance Plans?

Understanding healthcare insurance can be complex. A common question concerns dental coverage: is it permissible to have more than one dental insurance plan simultaneously? This article explores the practicalities and implications of holding multiple dental insurance policies.

Having Multiple Dental Insurance Plans

Individuals can be covered by two or more dental insurance plans concurrently, a situation known as dual dental coverage. This often arises when an individual has benefits through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Another common scenario involves individuals holding two jobs, with each employer providing dental insurance benefits. Some people also purchase a private dental plan to supplement an existing employer-sponsored one.

Dual coverage does not mean an individual receives double the benefits, but it can significantly reduce out-of-pocket costs for dental procedures. This arrangement is permissible, and many insurance providers coordinate benefits between multiple plans. The aim of dual coverage is to increase the total amount covered for dental treatments, not to allow for duplicate payments. How the plans interact is determined by the terms of each policy and the rules governing benefit coordination.

Understanding Coordination of Benefits

When an individual has two dental insurance plans, Coordination of Benefits (COB) rules govern payment coordination. COB ensures that combined payments from both insurance carriers do not exceed 100% of the dental procedure’s cost, preventing individuals from profiting. COB rules establish which plan is the “primary” insurer and which is the “secondary” insurer.

The primary plan pays benefits first, based on its terms and conditions. After the primary plan processes the claim and pays its portion, any remaining balance is submitted to the secondary plan. The secondary plan reviews the claim and may pay additional benefits according to its policy, up to the allowed amount for the service.

Determining which plan is primary depends on several factors. For children covered by both parents’ dental plans, the “birthday rule” applies: the plan of the parent whose birthday falls earlier in the calendar year is primary. If an individual has coverage through their own employer and as a dependent under a spouse’s plan, their own employer-sponsored plan is usually primary. For individuals with two employer-sponsored plans, the plan that has provided coverage for the longest duration may be primary.

Some dental plans may include a “non-duplication of benefits” clause. This clause can impact the secondary plan’s payment, potentially preventing it from paying benefits if the primary plan has already paid an amount equal to or greater than what the secondary plan would have paid. Understanding these COB provisions within each policy is important for maximizing the advantages of dual coverage.

Navigating Claims with Multiple Plans

When seeking dental care with dual coverage, submit the dental claim to the primary insurance carrier first. This allows the primary insurer to process the claim according to its policy terms, applying any deductibles, copayments, or coinsurance amounts. Once reviewed, the primary insurer issues an Explanation of Benefits (EOB).

The EOB details how the claim was processed, the amount paid by the primary plan, and any remaining balance. After receiving this EOB, the individual or their dental provider submits the claim to the secondary insurance carrier, typically including a copy of the primary EOB. The secondary plan reviews the claim and primary EOB to determine what additional benefits, if any, it will pay.

The secondary plan’s payment considers the amount already paid by the primary plan. For example, if a procedure costs $100 and the primary plan pays $80, the secondary plan may cover a portion of the remaining $20, up to its allowed amount, considering its deductibles, copayments, or annual maximums. The secondary plan aims to cover remaining eligible costs, potentially reducing the patient’s out-of-pocket expense.

Having two plans does not mean annual maximums are doubled. Each plan has its own annual maximum, and COB ensures the combined payout does not exceed the total cost of the treatment. The patient remains responsible for any balance not covered by either plan, such as amounts exceeding allowed charges or services not covered by policy.

Managing Your Multiple Dental Plans

Managing multiple dental plans requires proactive communication and diligent record-keeping. Inform both insurance companies that you have other coverage. This disclosure enables them to properly apply Coordination of Benefits rules from the outset, preventing delays or complications in claim processing. Many plans require this information to determine primary and secondary status.

Maintain detailed records of all dental treatments, claims submitted, and payments received from both insurers. Keep copies of all Explanation of Benefits (EOBs) from both the primary and secondary plans. These documents provide a clear breakdown of how each claim was processed, amounts paid by each insurer, and your final out-of-pocket responsibility. Organized records facilitate tracking remaining benefits and annual maximums.

Regularly review EOBs from both plans to ensure benefits have been applied correctly and to understand any remaining balances. Discrepancies or questions about benefit coordination should prompt a call to the relevant insurance provider for clarification. This proactive approach helps resolve billing issues promptly and confirms you receive full benefits.