Can I Have Two Dental Plans at the Same Time?

It is generally possible to have more than one dental plan simultaneously, a situation often referred to as dual dental coverage. While this arrangement does not typically result in double benefits, it can significantly influence how dental care costs are managed. Understanding how these plans interact is important for navigating your financial responsibilities related to dental treatments.

When Having Two Dental Plans is Possible

Individuals can find themselves with two dental plans through various common scenarios. One frequent situation arises when an individual has dental coverage through their own employer and is also covered as a dependent under a spouse’s or parent’s dental plan. Another instance occurs when a person works two jobs, and both employers offer dental benefits. Additionally, someone might maintain an employer-sponsored plan while also purchasing a separate individual dental plan to supplement their coverage.

How Dental Plans Coordinate Benefits

When an individual has two dental plans, the process known as Coordination of Benefits (COB) determines how the plans work together to pay for dental services. The purpose of COB is to prevent over-insurance or duplication of benefits, ensuring that the combined payments from both plans do not exceed the total cost of the procedure. One plan is designated as the “primary” payer, which processes the claim first, and the other is the “secondary” payer, covering remaining costs up to its limits.

Several rules dictate which plan is primary. The plan in which an individual is enrolled as an employee or the main policyholder is primary over a plan where they are a dependent. If a person has dental benefits through two employers, the plan that has provided coverage for the longest duration is considered the primary one. For dependent children covered by both parents’ plans, the “birthday rule” applies, meaning the plan of the parent whose birthday occurs earlier in the calendar year (month and day) is primary.

In situations involving divorced or separated parents, a court decree specifying responsibility for dental care takes precedence over the birthday rule. If a dental procedure is also covered by a medical plan, such as oral surgery, the medical plan is primary. It is important to note that COB provisions are mandated for group (employer-sponsored) plans, while individual plans may not be required to coordinate benefits.

How Dual Coverage Affects Your Dental Care Costs

The two plans coordinate to reduce your out-of-pocket expenses. The primary plan pays its portion first, and then the secondary plan may cover additional costs, often up to the combined allowed amount for the service.

Deductibles and annual maximums also play a role in dual coverage. A deductible is the amount you must pay before your insurance begins to cover costs, and this applies to the primary plan first. Once the primary plan has paid its share, the secondary plan may help cover the remaining balance, potentially reducing your personal financial outlay. For example, if a procedure costs $1,000, and your primary plan covers 80% after a $50 deductible, it would pay $760 (80% of $950). Your secondary plan might then cover a portion of the remaining $240, depending on its specific terms and coordination rules.

Some secondary plans may have a “non-duplication of benefits” clause. This provision means that if the primary plan paid as much or more than what the secondary plan would have paid if it were primary, the secondary plan may not pay anything further. Conversely, “traditional COB” allows the combined benefits from both plans to reach up to 100% of the covered expenses. Another method, “maintenance of benefits” (MOB), reduces the covered charges by the primary plan’s payment before applying the secondary plan’s deductible and coinsurance, which can leave the patient with some remaining cost. Understanding these specific clauses within your secondary plan is important for anticipating your final out-of-pocket costs.

Managing Your Dual Dental Coverage

Effectively managing dual dental coverage involves several procedural steps to ensure claims are processed correctly and you receive the full coordination of benefits. It is important to inform both dental insurance companies that you have additional coverage. This proactive communication helps them correctly apply coordination of benefits rules from the outset.

You should familiarize yourself with the specific rules of each plan, including their in-network providers, waiting periods for certain procedures, and any exclusions. This understanding helps in choosing providers and timing treatments appropriately. When submitting claims, the primary insurer will process the claim first and issue an Explanation of Benefits (EOB).

You will then need to send this EOB from the primary insurer to your secondary insurer for them to consider additional payment. Reviewing each EOB carefully allows you to track payments and understand your remaining financial responsibility. For detailed information specific to your situation, contacting the customer service departments of both insurance providers or your employer’s human resources department can provide clarity on how your particular plans coordinate.