Can You Have 2 Dental Insurance Plans?
Navigate the possibilities of holding multiple dental insurance plans and understand how they work together for your benefit.
Dental insurance provides coverage for services and treatments related to oral health care, helping individuals manage the costs of routine cleanings, exams, and various dental procedures. These plans typically cover a portion of expenses, reducing the financial burden on individuals. While some dental plans focus primarily on preventive care, others offer more extensive coverage for major dental work like crowns or implants. Understanding the specifics of a dental plan is important, including coverage limits, waiting periods for certain procedures, and whether a preferred dentist participates in the plan’s network.
Having More Than One Dental Plan
It is possible to have more than one dental insurance plan, known as dual dental coverage. This does not mean benefits are automatically doubled; instead, two plans work together to cover dental expenses.
Individuals often have dual coverage through common situations. For instance, an individual might have coverage through their own employer and also be covered as a dependent under a spouse’s employer-sponsored plan.
Another common situation is holding two jobs where both employers provide dental benefits. Dual dental coverage can also occur if someone has an employer-provided plan and supplements it with an individual dental plan.
While multiple plans do not guarantee complete coverage, they can significantly reduce out-of-pocket expenses by sharing treatment costs between carriers. Coordination of Benefits governs how these multiple plans interact.
How Coordination of Benefits Works
Coordination of Benefits (COB) is the process by which multiple dental plans determine the order they pay benefits. This process prevents over-insurance, ensuring combined payments do not exceed the total cost of services. One dental plan is designated as the “primary” plan, which pays first, and the other is the “secondary” plan, covering remaining eligible costs.
Which plan is primary depends on specific COB rules. For adults, the plan where the individual is the main policyholder is typically primary. If an individual has two jobs with dental benefits, the plan they enrolled in first is usually primary.
When dependents are covered by both parents’ plans, the “birthday rule” often applies; the plan of the parent whose birthday falls earlier in the calendar year is primary. In cases of divorced or separated parents, a court decree specifying responsibility for healthcare expenses takes precedence over the birthday rule.
After the primary plan pays, the secondary plan assesses the remaining balance. Its payment is typically limited to the lesser of its normal benefit or the patient’s remaining out-of-pocket costs. Some dental plans include a “non-duplication of benefits” clause. If the primary plan paid the same or more than what the secondary plan would have paid, the secondary plan may not make any additional payment. Another COB method is “carve-out,” where the secondary plan calculates its normal benefit and reduces it by what the primary plan paid.
The Claims Process with Multiple Plans
When a patient has multiple dental insurance plans, the claims process involves a specific sequence. First, identify which plan is primary and which is secondary; this information is typically found in your plan documents or by contacting your insurance providers.
The dental office submits the claim to the primary insurer first. After processing, the primary insurer issues an Explanation of Benefits (EOB). This EOB details the services received, the amount charged, the portion covered by primary insurance, and any remaining patient responsibility.
The EOB is not a bill, but it is necessary for the next step. You then submit the claim, along with the EOB from the primary insurer, to your secondary plan.
The secondary plan reviews the claim and primary EOB to determine what remaining eligible balance it will cover, up to its own coverage limits. Combined payment from both plans usually cannot exceed the total allowed amount for services. Provide accurate and complete information on all claim forms to facilitate smooth processing.