Can You Have Double Dental Insurance?

How Multiple Plans Operate

Having multiple dental insurance plans often involves a process known as Coordination of Benefits (COB). This system prevents individuals from receiving more than 100% of the cost of dental services when covered by two or more plans. COB rules establish an order of payment, ensuring benefits are distributed fairly. The primary plan pays its benefits first, followed by the secondary plan.

Determining which plan is primary and secondary is a structured process. For individuals covered by their own employer’s plan and a spouse’s plan, the individual’s own plan is typically primary. When dependent children are covered by both parents’ plans, the “birthday rule” applies; the plan of the parent whose birthday falls earlier in the calendar year is designated as the primary plan. This rule provides a consistent method for sequencing benefits.

Once the primary plan processes a claim, it pays benefits according to its terms and conditions, including deductibles and co-payments. Any remaining balance is then submitted to the secondary plan. The secondary plan reviews the claim, applying its own COB rules, and may pay additional benefits up to its maximum allowable amount, potentially reducing the patient’s out-of-pocket expenses.

Submitting Claims with Multiple Plans

Submitting a dental claim with multiple insurance plans begins with the primary insurer. After receiving dental services, the dental provider typically submits the claim directly to your primary insurance plan. This initial submission details the services rendered, the cost, and the portion covered by the primary plan. Ensure the provider has accurate and up-to-date information for your primary coverage.

Once the primary insurer processes the claim, they issue an Explanation of Benefits (EOB) statement. This document outlines what the primary plan paid, what portion was applied to your deductible, any co-payments, and the remaining balance. The EOB is a detailed record of how the primary plan adjudicated the claim.

After receiving the primary EOB, you or your dental provider will submit the claim and a copy of the primary EOB to your secondary insurance plan. The secondary insurer will review the claim, taking into account the payment made by the primary plan and applying its own benefits and Coordination of Benefits rules. They will then pay any additional eligible amount, reducing your financial responsibility for the dental services.

Important Considerations for Multiple Plans

Maintaining multiple dental insurance plans introduces additional premium costs. Each plan requires its own premium payments, and these combined costs can be substantial depending on the specific plans chosen. It is important to weigh these recurring expenses against the potential benefits of having broader coverage.

While having more than one plan can reduce out-of-pocket expenses for extensive or costly dental procedures, it does not mean receiving double the benefit or cash back. Coordination of Benefits rules prevent overpayment, so the total reimbursement from both plans will not exceed the actual cost of the dental service. This arrangement can be particularly beneficial for procedures like orthodontics or complex restorative work, where costs can be high.

Managing two sets of benefits and rules also requires administrative effort. Individuals must understand the specific terms, deductibles, annual maximums, and covered services for each plan. This includes keeping track of EOBs and potentially coordinating claim submissions between the dental provider and both insurers. Understanding these details helps ensure that claims are processed efficiently.