Can I Have Two Dental Insurances? How It Works

Many individuals consider holding more than one dental insurance plan to enhance coverage. Navigating dental benefits can be complex, especially with multiple sources. Understanding how these plans interact and coordinate benefits is essential for maximizing advantages and managing costs. This guide clarifies the process of utilizing multiple dental insurance policies.

Eligibility for Multiple Dental Insurance Plans

Having more than one dental insurance plan, or dual dental coverage, is generally permissible. This often arises when an individual has two jobs providing dental benefits, or is covered by a spouse’s plan in addition to their own employer-sponsored coverage. Children may also have dual coverage if both parents carry separate dental plans. Dual coverage does not typically result in double benefits, but rather provides a more comprehensive approach to managing dental expenses.

Understanding Coordination of Benefits

When an individual has dual dental coverage, the interaction between plans is governed by Coordination of Benefits (COB). The primary purpose of COB is to prevent overpayment and avoid duplicating benefits, ensuring combined payments do not exceed the total cost of dental services. COB rules establish which plan pays first (primary) and which pays second (secondary).

Determining the primary and secondary plan depends on specific rules. Generally, the dental plan where an individual is enrolled as the employee or main policyholder is primary. If a person has dental benefits from two employers, the plan that has covered the individual for the longest period is typically primary. For dependent children covered by both parents’ plans, the “birthday rule” usually applies; the plan of the parent whose birthday falls earlier in the calendar year (month and day, not year) is the primary insurer. Court orders for divorced or separated parents can override the birthday rule, specifying which parent’s plan is primary.

Once the primary plan processes a claim, the secondary plan considers the remaining balance. The secondary plan typically pays after the primary plan has applied its benefits, often covering costs not covered by the primary plan. Some plans may include a “non-duplication of benefits” clause, meaning the secondary plan might pay nothing if the primary plan’s payment equals or exceeds what the secondary plan would have paid. COB can significantly reduce out-of-pocket expenses by covering gaps left by the primary plan’s coverage.

Submitting Claims with Multiple Plans

Submitting claims with multiple dental insurance plans requires understanding primary and secondary coverage. When you receive dental services, the claim must first be submitted to your primary insurance provider. The dental office typically handles this initial submission.

After the primary insurance plan processes the claim, they will issue an Explanation of Benefits (EOB). An EOB is a detailed statement, not a bill, explaining how your claim was processed. It outlines services rendered, total charges, the amount the primary insurance covered, and any remaining balance. Reviewing the EOB is crucial as it confirms payments made by your primary plan and indicates any amounts you may still owe.

Once you receive the EOB from your primary insurer, you or your dental office will submit the claim to your secondary insurance provider. This submission must include a copy of the primary plan’s EOB. The secondary insurer uses this EOB to determine their payment responsibility based on their policy terms and coordinated benefits rules. Both submissions require essential information like patient details, provider information, service codes, and dates of service. While many dental offices manage direct billing to both primary and secondary insurers, some may require the patient to handle the secondary claim submission themselves.