Can You Have Two Dental Insurance Plans?
Understand how multiple dental insurance plans can operate concurrently to optimize your coverage and manage costs.
Dental insurance plans help manage oral healthcare costs, providing access to services from routine check-ups to more involved procedures. Many people obtain dental coverage through their employer, a spouse’s employer, or by purchasing an individual plan.
The Possibility of Dual Coverage
It is possible to have more than one dental insurance plan simultaneously, a situation known as dual coverage. This is a common occurrence. For example, a person might have coverage through their own employer and also be covered as a dependent under a spouse’s employer-sponsored plan. Another common scenario involves an individual holding a private dental plan in addition to an employer-provided group plan. Dual coverage can also arise when a child is covered under the dental plans of both parents. While having multiple plans is not uncommon, it does introduce a specific process for how benefits are applied.
Understanding Coordination of Benefits
When an individual has two dental plans, a process known as Coordination of Benefits (COB) comes into play. COB is the mechanism insurance companies use to determine which plan pays first (the primary plan) and how the second plan (the secondary plan) contributes to the remaining costs. COB ensures that the combined payments from both plans do not exceed the total cost of the dental service, preventing overpayment.
The determination of primary and secondary plans follows established rules. Generally, the plan covering the individual as an employee or main policyholder is considered primary, while a plan where they are covered as a dependent is secondary. For children covered under both parents’ plans, the “birthday rule” typically applies: the plan of the parent whose birthday falls earlier in the calendar year is designated as the primary plan. Legal documents, such as court orders in cases of divorce, can override the birthday rule, specifying which parent’s plan is primary.
Once the primary and secondary plans are identified, the claim submission process begins. The dental office first submits the claim to the primary insurance plan. After the primary plan processes the claim and pays its portion, an Explanation of Benefits (EOB) is issued, detailing what was covered and any remaining balance. This EOB is then submitted to the secondary plan, which reviews the remaining eligible costs and may cover an additional portion, adhering to its own COB rules.
Financial Implications of Dual Coverage
Dual dental coverage, managed through Coordination of Benefits, can significantly affect a policyholder’s out-of-pocket expenses. The secondary plan often helps to reduce or eliminate the remaining costs after the primary plan has paid, including deductibles, copayments, and coinsurance. A deductible is the amount an individual must pay before their insurance begins to cover costs. Copayments are fixed amounts paid at the time of service, while coinsurance represents a percentage of the service cost that the policyholder is responsible for after the deductible is met.
For example, if a dental procedure costs $500, and the primary plan pays 80% after a $50 deductible, the primary plan would pay $360 ($450 x 80%) after the deductible is met, leaving $90 as coinsurance and the $50 deductible. The secondary plan then assesses the remaining $140 ($50 deductible + $90 coinsurance). Depending on its terms, the secondary plan might cover a portion or all of this remaining amount, potentially reducing the policyholder’s out-of-pocket expense to zero.
Dental plans have annual maximums, which represent the total amount the plan will pay for covered services within a benefit year. While dual coverage can reduce personal costs, the combined payments from both plans usually cannot exceed 100% of the covered service’s cost or the dentist’s total fee. This means that even with two plans, individuals will not receive more than the actual cost of the treatment.