Can You Have Two Dental Insurance Plans?

Having multiple dental insurance plans, known as dual dental coverage, is generally possible. This arrangement allows individuals to be covered by more than one policy simultaneously. Understanding how these plans interact can offer enhanced benefits for dental care.

Having Multiple Dental Plans

Individuals acquire two dental insurance plans through common scenarios. For instance, a person could have coverage through their own employer and also be covered as a dependent on a spouse’s employer-sponsored plan. Another situation arises if someone holds two jobs, and both employers provide dental benefits. Individuals can also purchase an individual dental plan to supplement an employer-provided one.

Dual coverage is permissible, but its purpose is not to provide double benefits for the same dental procedure. Its goal is to enhance overall coverage and reduce out-of-pocket expenses.

Understanding Coordination of Benefits

When an individual has two dental plans, Coordination of Benefits (COB) determines how the plans pay for services. COB ensures the total payment from both plans does not exceed 100% of the allowed charges. One plan is designated as the “primary” insurer, which pays first, and the other becomes the “secondary” insurer, covering any remaining eligible balance.

Rules for determining primary versus secondary plans are established by state laws and insurance company guidelines. The plan covering an individual as an employee or main policyholder is primary over a plan where they are covered as a dependent. If a person has two employer-sponsored plans, the plan that has covered them for the longest period is considered primary. For dependent children covered by both parents’ plans, the “birthday rule” applies; the plan of the parent whose birthday falls earlier in the calendar year (month and day) is primary. In cases of divorced or separated parents, a court decree specifies which parent’s plan is primary, overriding the birthday rule.

After the primary insurer processes a claim and pays its portion, an Explanation of Benefits (EOB) is issued, detailing the paid amount and remaining balance. This EOB is then submitted to the secondary insurer, which reviews the claim and pays additional eligible costs, adhering to its policy terms and COB provisions. Only group (employer) plans are required to coordinate benefits; individual plans do not coordinate with employer plans or other individual plans.

Maximizing Your Coverage

Dual dental coverage offers advantages, primarily reduced out-of-pocket costs by having the secondary plan cover expenses not fully paid by the primary insurer (e.g., deductibles, copayments, coinsurance). This is beneficial for expensive procedures or if the primary plan has lower annual maximums, as the secondary plan extends overall benefits. Dual coverage can also provide access to a broader network of dentists or cover services a single plan might exclude.

Maintaining two dental plans has considerations. Policyholders pay premiums for both, resulting in higher costs unless one plan is employer-paid. While dual coverage aims to reduce patient costs, combined payments will not exceed total allowed charges. Some plans include a “non-duplication of benefits” clause, where the secondary plan pays nothing if the primary plan’s payment equals or exceeds what the secondary plan would have paid as primary.

Managing claims with two insurers introduces administrative complexity, requiring documentation submission to both. Understanding each policy’s specific COB terms is important, as these vary and impact final payment. For those with significant dental needs, dual coverage offers a financial safety net by covering a larger portion of dental expenses up to the allowed amount.