Can You Combine Dental Insurance & How Does It Work?

Combining or coordinating dental insurance plans can help manage dental care costs. This process operates through Coordination of Benefits (COB). COB prevents overpayment and ensures fair cost distribution when an individual has multiple health or dental plans. When multiple plans are in place, COB establishes a clear order for how each plan contributes to the cost of services.

The Coordination of Benefits Principle

Coordination of Benefits (COB) determines the order in which multiple insurance plans pay for covered services. When an individual has more than one insurance plan, COB identifies which plan pays first, known as the primary plan, and which pays second, or the secondary plan. The primary plan processes the claim and pays its portion of the coverage first. The secondary plan then reviews the claim and may pay for remaining eligible expenses, up to its own benefit limits or the total cost of the service.

COB rules prevent duplicate payments and ensure combined benefits do not exceed the total cost of treatment. Common rules determine which plan is primary. For instance, coverage obtained through employment is typically primary over an individual plan. If a person has coverage through two employers, the plan from the employer providing coverage for the longest time may be considered primary.

For children covered by both parents’ plans, the “birthday rule” is used. This rule designates the plan of the parent whose birthday falls earlier in the calendar year as the primary plan. If a court order or divorce decree specifies which parent is responsible for a child’s dental expenses, that order takes precedence. When an individual is covered as an employee on one plan and as a dependent on another, the plan covering them as an employee is primary.

Applying Coordination of Benefits to Dental Plans

The principles of Coordination of Benefits apply directly to dental insurance plans, especially with dual coverage. This can occur when an individual is covered by their own employer’s plan and also as a dependent on a spouse’s plan, or when a child is covered by both parents’ dental plans. Even if a medical plan covers some dental-related benefits, such as treatment for accidental injuries or oral surgery, that medical plan is primary over a standalone dental plan.

When coordinating dental benefits, the secondary plan considers the primary plan’s payments before calculating its own contribution. This process reduces the patient’s out-of-pocket costs, though it does not guarantee 100% coverage or eliminate all expenses, as deductibles, copayments, and coinsurance may still apply. The combined benefits from all plans cannot exceed the higher of the two plans’ annual maximum limits or the actual expenses incurred.

Some dental plans may include a “non-duplication of benefits” clause. This clause means the secondary plan 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 if it were primary. Such clauses are common in self-funded employer plans and can result in higher out-of-pocket costs for the patient. To understand how your specific dental plans will coordinate, review each policy’s documents for details on COB clauses.

Submitting Claims with Multiple Dental Plans

When you have multiple dental plans, the claim submission process begins with your dental provider. The dental office bills the primary insurance plan first for services. After the primary plan processes the claim, it sends an Explanation of Benefits (EOB) statement to both the patient and the provider. This document is an itemized summary detailing services, total charges, the amount paid by the primary insurer, and any remaining balance.

Upon receiving the EOB from the primary plan, the next step involves submitting this EOB, along with the original dental bill, to the secondary insurance plan. The secondary plan then assesses the remaining costs based on its own coverage terms and the payment made by the primary plan. Many dental offices assist with or handle submission to the secondary insurer.

Maintain records of all submitted claims, EOBs, and communications with both insurance companies. If a claim is denied or questions arise regarding coordination of benefits after submission, contact the insurance companies directly.