Can You Have More Than 1 Dental Insurance?

Dental insurance plays a significant role in managing the costs associated with maintaining oral health, covering a range of services from preventive care to more extensive procedures. Many individuals wonder if holding more than one dental insurance policy is permissible and how such arrangements function. This article aims to clarify these aspects and the implications of dual dental coverage.

Having Multiple Dental Plans

It is generally possible to have more than one dental insurance policy. This scenario, often referred to as dual coverage, occurs when an individual is enrolled in two or more separate dental plans simultaneously. These plans can originate from various sources, such as through one’s own employer, a spouse’s employer, or an individually purchased policy. A specific process is followed to coordinate payments between the different insurers, as benefits are not simply doubled.

Understanding Coordination of Benefits

When an individual has dual dental coverage, plans operate under a system known as Coordination of Benefits (COB). COB is designed to prevent overpayment by ensuring that total reimbursement from all plans does not exceed 100% of the dental service’s cost. This process determines which plan pays first, designated as the “primary” insurer, and which pays second, known as the “secondary” insurer.

The primary plan is always billed first and processes the claim according to its terms. After the primary insurer has paid its portion, an Explanation of Benefits (EOB) statement is issued. This EOB is then submitted to the secondary insurer, which may cover additional costs, up to its own benefit limits. Rules for determining primary and secondary status vary. Common guidelines include the “Birthday Rule” for children of married parents, where the parent whose birthday falls earlier in the calendar year has the primary plan. For employed individuals, the plan covering them as an employee is typically primary over a plan where they are a dependent.

Some dental plans may include a “Non-Duplication of Benefits” clause, which can significantly affect how the secondary plan pays. Under this clause, if the primary plan’s payment equals or exceeds what the secondary plan would have paid, the secondary plan may not make any additional payment. This means the patient could still be responsible for remaining costs if the secondary plan has such a provision. In contrast, traditional COB aims for the combined benefits from both plans to cover up to 100% of the covered expenses.

Common Reasons for Dual Coverage

Dual dental coverage can arise from several common situations, often without an individual intentionally seeking multiple plans. A frequent scenario involves spousal coverage, where one spouse is covered by their employer’s dental plan and is also included as a dependent on their partner’s employer-sponsored plan. Similarly, an individual who holds two jobs, both of which offer dental benefits, may find themselves with dual coverage.

Children are often covered by multiple plans, particularly when both parents have dental insurance through their respective employers. In such cases, the child may be listed as a dependent on both parents’ policies, leading to dual coverage. Some individuals also choose to purchase a private dental plan in addition to their employer-sponsored coverage to supplement benefits or access a wider network of providers.

Financial Considerations

Having dual dental insurance can offer financial advantages by potentially reducing out-of-pocket expenses for dental procedures. While total payments will not exceed 100% of the service cost, dual coverage can help cover deductibles, co-pays, and co-insurance amounts that a single plan might leave to the patient. This enhanced coverage can be particularly beneficial for more extensive treatments, where costs can accumulate rapidly.

Dual coverage may also provide access to a broader range of dental services or a larger network of providers, depending on the specifics of each plan. If one plan has limitations on certain procedures or a restricted network, the secondary plan might offer coverage or access to alternative providers. However, the cost of premiums for maintaining two plans should be weighed against the potential savings on dental work. The actual financial benefit depends on the specific terms, allowances, and Coordination of Benefits rules of the individual policies involved.