Can You Have Dual Dental Insurance?

Dental insurance serves as a financial tool designed to help manage the costs associated with dental care. It typically covers a range of services from preventive check-ups to more involved procedures. Individuals often obtain this coverage through various avenues, including employer-sponsored plans, private insurance marketplaces, or government programs. It aims to reduce out-of-pocket expenses for maintaining oral health, an important component of overall well-being.

Possessing Multiple Dental Plans

It is possible to have more than one dental insurance plan simultaneously, often referred to as dual dental coverage. This arrangement can arise from several common circumstances. For instance, an individual might have a dental plan provided by their employer while also being covered as a dependent under a spouse’s or parent’s insurance policy. Another scenario involves purchasing a supplemental private plan in addition to an employer-sponsored one, which can help address specific needs or extend benefits. Children often have dual coverage, enrolled as dependents on both parents’ separate dental plans.

Understanding Coordination of Benefits

When an individual has more than one dental insurance plan, Coordination of Benefits (COB) determines the order in which plans pay for services. COB prevents overpayment, ensuring combined benefits do not exceed the total procedure cost.

COB rules establish which plan is considered the “primary” payer and which is the “secondary” payer. The primary plan processes the claim first and pays its portion according to its benefits and fee schedule. After the primary plan has paid, the secondary plan then reviews any remaining balance. The secondary plan contributes up to its allowable amount, considering what the primary plan covered. State laws and regulations often mandate how COB is applied, meaning the specific rules can vary among different insurance providers and jurisdictions. The goal is to maximize the benefits received by the patient.

How Claims are Processed

The processing of dental claims when an individual has two insurance plans follows a specific sequence. Initially, the dental provider submits the claim to the primary insurance company. This plan evaluates the claim based on its policy terms and pays its determined share of the cost.

After the primary insurer processes the claim, they issue an Explanation of Benefits (EOB) statement. This document details coverage, amount paid, and any remaining balance. The remaining balance and the primary EOB are then submitted to the secondary insurance company.

The secondary plan reviews the claim and the primary EOB to determine its payment. It covers its portion of the remaining balance, up to its policy limits and fee schedule. This approach ensures both plans contribute to treatment costs, helping to reduce the patient’s out-of-pocket expenses.

Rules for Dependents

Specific rules dictate how primary and secondary dental coverage is determined for dependents covered by both parents’ plans. The most common guideline is the “birthday rule.” Under this rule, the dental plan of the parent whose birthday falls earlier in the calendar year is designated as the primary insurer. Only the month and day matter for this determination, not the year of birth.

For example, if one parent’s birthday is in April and the other’s is in September, the April birthday parent’s plan would be primary. This rule provides a standardized method for insurers to coordinate benefits. This rule can be superseded by a court order in cases of divorce or legal separation. In situations where both parents share the same birthday, the plan that has provided coverage for the longest period typically becomes the primary.