Can You Have a Secondary Dental Insurance?

Dental insurance helps manage oral healthcare costs, covering services from routine cleanings to complex procedures. Many individuals wonder if they can or should have more than one dental insurance policy. This often arises from personal or employment situations, leading to questions about holding multiple plans and how they interact.

Understanding Dual Dental Coverage

It is permissible to have more than one dental insurance plan, often called dual dental coverage. This commonly arises when an individual is covered by their own employer’s plan and also as a dependent on a spouse’s employer-provided plan. Other instances include holding an individual policy in addition to an employer-sponsored plan, or working two jobs where each employer offers dental benefits.

The primary purpose of dual dental coverage is to potentially reduce out-of-pocket expenses for dental treatments or to expand the scope of covered services. While having two plans does not mean benefits are simply doubled, it can lead to lower personal costs for procedures. This arrangement aims to provide a broader financial safety net for dental care needs.

How Benefits Are Coordinated

When an individual has dual dental coverage, the process by which the two plans work together to pay for services is called Coordination of Benefits (COB). COB rules ensure that combined payments from both plans do not exceed the total cost of the dental service. The plans determine which one is primary and which is secondary.

The primary plan is typically the one that covers the individual as an employee or the main policyholder. For instance, if you have dental insurance through your job and are also covered under your spouse’s plan, your employer’s plan is usually primary. The secondary plan then covers remaining costs up to its own limits after the primary plan has paid its portion. When a dental claim is submitted, the primary plan processes and pays its benefits first. An Explanation of Benefits (EOB) from the primary insurer is then sent to the secondary insurer, which may cover the remaining balance, subject to its policy terms and limitations.

For children covered by both parents’ dental plans, the “birthday rule” often determines which plan is primary. Under this rule, the plan of the parent whose birthday falls earlier in the calendar year (month and day) is considered primary. If both parents share the same birthday, the plan that has been active longer typically becomes primary. Some dental plans may include a “non-duplication of benefits” clause. This provision means the secondary plan might not pay 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.

Key Factors When Considering Dual Coverage

Before committing to a secondary dental insurance plan, evaluating several practical considerations is important. The cost of paying two separate premiums might, in some cases, outweigh the additional benefits received, especially if Coordination of Benefits rules significantly limit secondary payouts. A thorough cost-benefit analysis comparing premiums against potential savings on dental care is advisable.

Each dental plan typically has its own annual maximums and deductibles. While dual coverage can help reduce out-of-pocket costs, you may still need to meet separate deductibles for each plan before benefits apply. The secondary plan’s payment will also be subject to its own annual maximums and other limits, even after the primary plan has contributed.

New dental plans often impose waiting periods for specific procedures, especially for basic or major dental work. Even with dual coverage, these waiting periods, which can range from a few months to a year for certain services, may still apply to the new policy. Managing two dental plans can also introduce administrative complexities, involving more paperwork and coordination with dental offices regarding claims processing. It is always beneficial to review both policies carefully for any specific exclusions, limitations, or unique COB rules that could impact your coverage.