Can I Use Two Dental Insurance Plans?

Having more than one dental insurance plan, often called dual dental coverage, is a common arrangement for many individuals. Understanding how these plans interact is important for maximizing benefits and managing dental care costs effectively. It is possible to utilize both plans to help cover the expense of dental treatments.

How Multiple Dental Plans Work Together

When an individual holds coverage under two dental plans, their interaction is governed by Coordination of Benefits (COB). COB is a set of rules insurers use to process claims and prevent overpayment when a patient has more than one plan. Its goal is to ensure combined payments do not exceed the total service cost.

Under COB, one dental plan is designated as the “primary plan,” and the other is the “secondary plan.” The primary plan processes and pays the claim first, according to its terms and benefits. After the primary plan pays its portion, the remaining eligible balance may then be submitted to the secondary plan.

The secondary plan reviews the claim and the primary plan’s payment, covering additional costs up to its benefit limits. This coordination helps reduce the patient’s out-of-pocket expenses. It is important to note that only group (employer) plans are typically required to coordinate benefits; individual plans generally do not coordinate in the same manner.

Identifying Your Primary and Secondary Plans

Determining which dental plan is primary and which is secondary is a structured process guided by established rules, though specific details can vary by insurer. The primary plan is generally the one that covers an individual as the main policyholder or employee. If you are covered by your own employer’s plan and also by your spouse’s plan, your employer’s plan is typically considered primary.

For children covered by both parents’ dental plans, the “Birthday Rule” is applied. This rule designates the plan of the parent whose birthday falls earlier in the calendar year (month and day, not year of birth) as the primary plan. However, court orders in cases of divorced or separated parents may override the Birthday Rule, dictating which parent’s plan is primary.

If an individual has dental coverage from two different employers, the plan that has provided coverage for the longest period is the primary plan. In situations where one plan is a group plan (e.g., through an employer) and the other is an individual plan, the group plan is the primary insurer. If one plan is active employment coverage and the other is a COBRA or retiree plan, the active employment plan is primary.

Navigating Claims with Dual Coverage

Submitting dental claims with dual coverage involves a specific sequence to ensure proper processing. The initial step requires submitting the claim to your primary dental insurance provider. This plan processes the claim according to its terms and then issues an Explanation of Benefits (EOB). The EOB is a statement detailing what the primary insurer has paid, the amount adjusted or disallowed, and your remaining financial responsibility.

Once the EOB from the primary insurer is received, the remaining balance can then be submitted to your secondary dental insurance plan. The secondary insurer requires a copy of the primary plan’s EOB to consider payment. This document provides the secondary plan with information about what the primary plan covered, allowing them to calculate their own benefit payment without duplicating benefits.

Many dental offices can assist with dual coverage claims. It is advisable to provide both insurance plan details to your dental provider’s office at the time of service. This allows them to submit claims in the correct order and streamline billing. However, it remains important to review EOBs from both insurers to ensure accuracy and understand your final out-of-pocket costs.

Understanding Coverage and Cost with Two Plans

Having two dental plans can significantly affect overall coverage and out-of-pocket expenses, but it does not mean double benefits. You still need to satisfy the primary plan’s deductible before its benefits begin. Some secondary plans may waive their own deductible if the primary plan’s deductible has already been met, while others may require it.

Annual maximums are another important consideration; while a secondary plan can help cover costs after the primary plan’s maximum is reached, you generally do not combine the annual maximums of both plans. For instance, if your primary plan has a $1,500 annual maximum and you reach it, your secondary plan might then contribute, but your total combined payout will not exceed the allowed amount for services.

The secondary plan’s role involves covering a portion of the remaining percentage of a covered service after the primary plan has paid. For example, if a primary plan covers 80% of a procedure, the secondary plan may cover the remaining 20%. However, some secondary plans include a “non-duplication of benefits” clause. This means they will not pay benefits if the primary plan paid the same or more than what the secondary plan would have paid as primary. This clause can limit additional coverage, emphasizing that dual coverage does not guarantee 100% coverage for all dental costs.