Can I Use Two Insurance for Dental Work?

Many individuals have more than one dental insurance plan, often through their employer, a spouse’s plan, or different jobs. Understanding the process and rules governing multiple dental insurance policies helps patients maximize their benefits and manage out-of-pocket expenses. This article explores how multiple dental insurance plans can be utilized effectively.

Understanding Coordination of Benefits

When an individual has more than one dental insurance policy, Coordination of Benefits (COB) determines which plan pays first for dental services. COB ensures an orderly payment sequence and prevents overpayment from multiple carriers for the same dental treatment.

The primary insurance plan is the first to pay for eligible dental expenses, applying its benefits, deductibles, and co-insurance requirements. After the primary plan processes the claim, any remaining eligible balance is considered by the secondary insurance plan. The secondary plan then pays according to its policy terms, often reducing the patient’s out-of-pocket costs.

The main purpose of COB is to ensure that total benefits from all plans do not exceed 100% of the dental service cost. This prevents individuals from profiting from their dental care. Common scenarios where COB applies include a person covered by their employer’s plan and as a dependent on a spouse’s plan, or when a child is covered by both parents’ separate dental policies.

Rules for Primary and Secondary Coverage

Specific rules determine which dental plan is primary and which is secondary. For children covered under both parents’ dental plans, the “Birthday Rule” applies. This rule designates the plan of the parent whose birthday falls earlier in the calendar year as the primary plan, regardless of age. For instance, if one parent’s birthday is in April and the other’s is in September, the April birthday parent’s plan would be primary.

Rules for determining primary coverage often relate to employment status. Coverage obtained through active employment is generally considered primary over COBRA, retiree plans, or individually purchased policies. If a person has coverage as an employee under one plan and as a dependent under another, the plan covering them as an employee is the primary payer.

If an individual has two dental plans through their own employment, primary coverage may depend on plan specifics or coverage length. Some secondary plans include a “Non-Duplication of Benefits” clause. This means they will not pay any benefits if the primary plan has already paid an amount equal to or greater than what the secondary plan would have paid. Reviewing individual policy documents is advisable, as rules can have specific interpretations or exceptions.

Submitting Claims with Multiple Plans

Submitting claims with multiple dental plans requires specific steps. Inform the dental provider’s office about both insurance plans at the time of service or appointment scheduling. Providing complete details for both policies, including policy numbers and group IDs, allows the office to manage billing accurately from the outset.

Following dental treatment, the dental office submits the claim first to the primary insurance carrier, including all necessary procedure codes and charges. Once the primary insurance processes the claim, they issue an Explanation of Benefits (EOB) statement to both the patient and the dental office. This EOB details what the primary plan paid, any amounts applied to the deductible, co-insurance, or non-covered services, and the remaining balance.

After receiving the primary EOB, the dental office or the patient submits the claim to the secondary insurance carrier. The EOB from the primary insurance must accompany this secondary claim submission. The secondary carrier uses the primary EOB to understand what was covered and paid by the first plan, which helps them determine their payment responsibility.

Upon receiving the secondary claim and the primary EOB, the secondary insurance processes the claim according to its policy terms, taking into account any remaining eligible costs and clauses like non-duplication of benefits. Patients should monitor the EOBs from both plans to understand how their benefits were applied and to identify any remaining out-of-pocket costs they may owe the dental provider.