Can You Have Two Dental Insurance Plans?

Navigating dental insurance can feel complex, especially when considering how to maximize coverage. A common question is whether it’s possible to be covered by more than one dental insurance plan. Understanding dental coverage helps in making informed decisions about healthcare.

Understanding Multiple Dental Plans

It is possible to have more than one dental insurance plan, often called dual dental coverage. This can occur when an individual has coverage through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Another instance might involve someone working two jobs, with each employer offering dental benefits. While permissible, this arrangement does not mean receiving double benefits or that all services will be covered without any out-of-pocket expenses.

How Coordination of Benefits (COB) Works

When an individual has more than one dental insurance policy, the process insurance companies use to determine which plan pays first is known as Coordination of Benefits (COB). This mechanism prevents duplicate payments for the same service, ensuring the total amount paid by all plans does not exceed the total allowed charges for the dental procedure. The plans establish a primary and a secondary insurer. The primary plan is generally the one that covers the individual as an employee or as the main policyholder, while a plan covering the individual as a dependent is secondary.

For dependent children covered by both parents’ plans, the “birthday rule” applies to determine the primary insurer. Under this rule, the plan of the parent whose birthday falls earlier in the calendar year (month and day) is considered primary. For example, if one parent’s birthday is in March and the other’s is in July, the March birthday dictates the primary plan. This rule can be superseded by a court order in cases of divorced or separated parents, which might specify which parent’s plan is primary.

The primary plan processes the claim first, paying its portion according to its terms and conditions. Any remaining balance, up to the allowed charges, is then considered by the secondary plan. This sequential approach ensures that the combined payout from both plans does not exceed 100% of the cost of services. It is worth noting that generally only group (employer-sponsored) plans are required to coordinate benefits, meaning individual policies may operate differently.

Submitting Claims with Multiple Plans

Submitting a claim with two dental insurance plans involves a specific sequence. First, submit the claim to your primary insurance provider. This allows the primary insurer to process the claim and determine their payment responsibility based on your plan’s coverage.

Once the primary insurer has processed the claim, they issue an Explanation of Benefits (EOB) document. This EOB details covered services, the amount paid by the primary plan, and any remaining balance. You then submit this EOB, along with the unpaid balance, to your secondary insurance provider. Many dental offices are equipped to handle this entire submission process for you, provided they are informed about both insurance plans from the outset.

Navigating Combined Coverage

Dual dental coverage introduces financial considerations that influence out-of-pocket costs. Policy components such as deductibles, annual maximums, and waiting periods interact differently when Coordination of Benefits is applied. You may be responsible for a deductible on your primary plan before its coverage begins, and potentially on your secondary plan as well, depending on its terms.

Each dental plan has an annual maximum, which is the total dollar amount the plan will pay for covered services within a 12-month period. While dual coverage can help extend the overall amount paid towards dental care, it does not mean your annual maximums are simply added together. Once the primary plan reaches its annual maximum, the secondary plan may then begin to contribute, potentially covering costs that exceeded the primary plan’s limit, up to its own maximum.

Some secondary plans may also include a “non-duplication of benefits” clause. This provision states that the secondary plan will not pay any benefits if the primary plan has already paid an amount equal to or greater than what the secondary plan would have paid as the primary insurer. This can result in higher out-of-pocket costs. Waiting periods for certain procedures may still apply to either or both plans.