Can You Have Primary and Secondary Dental Insurance?
Understand how primary and secondary dental insurance work together to manage your dental care costs effectively.
It is possible to have more than one dental insurance plan, often called dual dental coverage. This means an individual is covered by two separate policies. While multiple plans might seem to double benefits, the process coordinates payments to prevent duplication.
Understanding Multiple Dental Plans
Individuals can have primary and secondary dental insurance plans. The primary plan pays for services first, and the secondary plan provides additional coverage after the primary claim is processed. These designations are based on payment order. Common situations for dual dental coverage include being covered by one’s own employer-sponsored plan and a spouse’s plan. Another scenario involves a child covered as a dependent under both parents’ separate dental plans. Some individuals may also have a primary plan through their employer and an independently purchased individual plan.
How Coordination of Benefits Works
Coordination of Benefits (COB) is a process used by insurance companies when an individual has more than one dental plan. COB rules determine the order in which plans pay for services and prevent overpayment, ensuring combined benefits do not exceed the total cost of the dental procedure. The goal is to cover up to 100% of allowed charges.
Several common rules dictate which plan is primary and which is secondary. For dependent children, the “birthday rule” applies: the parent whose birthday occurs earlier in the calendar year has the primary plan. For adults, their own employer’s plan is typically primary over a spouse’s plan. If an individual has two jobs, the plan that has covered them for the longest duration is often designated as primary.
After the primary plan pays its portion, the secondary plan considers the remaining balance. The secondary plan applies its own coverage limits, deductibles, and co-insurance rules to the leftover amount. Some plans may include a “non-duplication of benefits” clause, meaning the secondary plan might not pay if the primary plan’s payment is equal to or greater than what the secondary plan would have paid. Generally, only group (employer-sponsored) plans are required to coordinate benefits, while individual policies may not.
Submitting Claims with Multiple Plans
Submitting a dental claim with primary and secondary insurance begins at the dental office. The office requires information for both plans, including policy numbers, group numbers, and subscriber details.
The dental office submits the claim to the primary insurance plan first. Once the primary plan processes the claim and makes its payment, it issues an Explanation of Benefits (EOB). This EOB details what the primary plan paid, what was covered, and any remaining patient responsibility.
The secondary plan requires a copy of this EOB from the primary insurer before processing its portion of the claim. The patient should review both EOBs to understand how much each plan contributed and any remaining out-of-pocket amount.
Practical Considerations for Multiple Plans
Having multiple dental plans can influence out-of-pocket expenses. While dual coverage may reduce costs for extensive procedures, the financial benefit depends on each policy’s specifics. For instance, the secondary plan might cover a portion of the remaining balance after the primary plan pays, potentially lowering co-payments or deductibles.
However, individuals must also consider the cost of premiums for each plan. For routine care, the added expense of a second premium might outweigh potential savings from reduced out-of-pocket costs. All dental plans have annual maximums, representing the highest amount the plan will pay for covered services within a benefit period.
Dual coverage does not combine or double these maximums. Instead, total reimbursement from both plans generally will not exceed the dentist’s total charge for the service. Review each policy for details on waiting periods, covered services, and how benefits are coordinated to understand the overall financial commitment and potential value.