Can I Use Two Dental Insurances?

Individuals can generally use more than one dental insurance plan simultaneously, a practice known as “dual dental coverage.” When covered by two plans, Coordination of Benefits (COB) determines how they work together to cover dental care costs. This process ensures appropriate coverage without duplicating benefits.

Understanding Coordination of Benefits

Coordination of Benefits (COB) is the procedure insurance plans follow to determine which plan pays first when an individual has more than one dental policy. This process prevents overpayment by ensuring total benefits do not exceed the actual cost of services. One plan is designated as the “primary” payer, processing the claim first, and the other becomes the “secondary” payer, covering remaining eligible costs.

Determining which plan is primary typically follows established rules. If an individual is covered by a dental plan through their own employment and also as a dependent on another plan, their own employer-sponsored plan is generally considered primary. For dependents, such as children covered by both parents’ plans, the “birthday rule” is commonly applied; the plan of the parent whose birthday falls earlier in the calendar year is usually primary, regardless of the birth year.

In situations where parents are divorced or separated, a court order often dictates which parent’s plan is primary for the children. If no court order exists, the birthday rule typically applies. When an individual has dental coverage through multiple employers, the plan that has covered the individual for the longest duration is usually designated as the primary plan.

Having two dental plans does not double benefits. Instead, plans coordinate to cover eligible expenses, potentially reducing out-of-pocket costs up to 100% of allowed charges. Some secondary plans include a “non-duplication of benefits” clause, meaning they will not pay additional amounts if the primary plan has already paid as much or more than the secondary plan would have paid.

Utilizing Dual Dental Coverage

When an individual has two dental insurance plans, inform both the dental provider and each insurance company about the dual coverage. Providing all policy details, including policy numbers and group numbers, allows the dental office to properly submit claims. This facilitates correct billing and prevents payment delays.

The process for filing claims with dual coverage involves the dental office first submitting the claim to the primary insurance carrier. After the primary insurer processes the claim and pays its portion, they will issue an Explanation of Benefits (EOB) document detailing what was covered and what remains. This EOB is then submitted to the secondary insurance carrier for consideration of the remaining balance.

The secondary plan will then review the claim and the primary EOB to determine its payment responsibility based on its own benefit provisions. While dual coverage can significantly reduce out-of-pocket expenses, individuals may still be responsible for deductibles, co-payments, and any charges that exceed the combined annual maximums of both plans. Predeterminations of benefits, which estimate coverage before treatment, are helpful but remain estimates and are not guarantees of payment.

Common Scenarios for Dual Dental Plans

Dual dental insurance coverage often arises from common situations. One frequent scenario involves married couples where both spouses have employer-sponsored dental insurance. Each spouse typically uses their own employer’s plan as primary, and can then be covered as a dependent under their spouse’s plan, which acts as secondary coverage.

Another common situation arises when an individual holds two jobs, and both employers offer dental benefits. The dental plan from the employer where the individual has been enrolled for the longest period usually serves as the primary plan. The plan from the newer employment then functions as the secondary coverage.

Children’s coverage also frequently involves dual dental plans, especially when parents have separate insurance policies. The “birthday rule” often applies, determining which parent’s plan pays first for the child’s dental care. For children of divorced parents, a court decree typically specifies primary dental coverage, overriding the birthday rule if an order is in place.