Can You Have 2 Dental Insurance Plans?
Uncover the realities of holding multiple dental insurance policies. Understand how dual coverage functions and what to evaluate for your needs.
Many individuals wonder about holding more than one dental insurance policy. This article explores the concept of having two dental insurance plans simultaneously, known as dual dental coverage, and how such arrangements function.
Understanding Dual Dental Coverage
Dual dental coverage occurs when an individual has benefits through their own employer and is also covered as a dependent under a spouse’s or parent’s plan, or holds two jobs offering benefits. Dual coverage means two plans work together to cover costs, not that benefits are doubled. The mechanism managing claims with two plans is Coordination of Benefits (COB).
Under dual coverage, one plan is “primary” and the other “secondary.” The primary plan pays its portion first, according to its benefit schedule. After the primary plan processes the claim, the secondary plan may then consider the remaining balance. This sequential payment process ensures claims are handled systematically.
How Coordination of Benefits Works
Coordination of Benefits (COB) is the standardized process insurance companies use to determine the order in which plans pay when an individual has dual dental coverage. Its goal is to prevent overpayment, ensuring the combined amount paid by both plans does not exceed the total cost of dental services. The primary plan pays its portion first, and the secondary plan may then cover eligible remaining costs, potentially reducing out-of-pocket expenses.
Rules exist to determine which plan is primary. Generally, the plan covering an individual as an employee or main policyholder is primary. If coverage is through a spouse’s plan, the individual’s employer-sponsored plan is usually primary, and the spouse’s plan is secondary. For dependent children, the “birthday rule” applies: the plan of the parent whose birthday (month and day) falls earlier in the calendar year is usually primary. In situations where an individual has coverage from two jobs, the plan they enrolled in first may be designated as primary.
A significant aspect of COB is the “non-duplication of benefits” clause, which can be present in some dental plans, particularly self-funded ones. This clause dictates that if the primary plan paid an amount equal to or more than what the secondary plan would have paid if it were primary, then the secondary plan will not make any payment. This means that even with two plans, the secondary plan may not contribute if the primary plan’s payout meets or exceeds its own potential payment, potentially leaving the patient with a balance.
Key Considerations for Dual Coverage
Evaluating dual dental coverage requires a careful assessment of its financial implications and the specific terms of each policy. Paying premiums for two plans can represent a significant ongoing cost, and individuals should weigh these expenses against the potential for reduced out-of-pocket spending on dental care. While dual coverage can lead to lower personal costs for procedures and may extend the overall coverage for expensive treatments, it does not mean that benefits are simply doubled.
Deductibles and annual maximums are important financial components to consider. Each plan will likely have its own deductible, which is the amount an individual must pay before the insurance begins to cover costs. Similarly, both plans will have annual maximums, which limit the total amount the insurer will pay within a given year. Understanding how these limits interact and if the secondary plan contributes after the primary’s annual maximum is reached is important.
Waiting periods also warrant attention when considering dual coverage. Many dental plans impose waiting periods, typically ranging from three months to a year, before they will cover basic or major procedures. While preventive care often has no waiting period, having a secondary plan might offer coverage for procedures during the primary plan’s waiting period, or after one plan’s annual maximum has been met. Thoroughly reviewing the specific terms, exclusions, and limitations of each individual plan is advisable to ensure they complement each other effectively and align with anticipated dental needs.