Can You Have Two Dental Insurance Plans at the Same Time?

Having more than one dental insurance plan at the same time is possible. Many individuals find themselves in situations where they are covered by their employer’s plan and also by a spouse’s plan, or perhaps an individual policy in addition to a group plan. While dual coverage can offer enhanced benefits, it also introduces complexity regarding how claims are processed and paid. Understanding these interactions helps maximize coverage and manage dental care costs.

Understanding Coordination of Benefits

Coordination of Benefits (COB) governs how multiple dental insurance plans work together. COB ensures benefits are paid fairly, preventing individuals from receiving more than 100% of service costs. This system distributes cost responsibility among insurers.

Determining which plan is primary and which is secondary is a foundational step in COB. For children covered by both parents’ plans, the “Birthday Rule” applies, designating the plan of the parent whose birthday falls earlier in the calendar year as primary. If one plan is an employer-sponsored group plan and the other is an individually purchased policy, the employer-sponsored plan is typically considered primary.

When an individual has coverage through their own employer and also through a spouse’s employer, their own employer-sponsored plan is primary. Similarly, if one plan is for an active employee and another is for a retired employee, the active employee’s plan takes precedence. Some policies may also include a “non-duplication of benefits” clause, which means the secondary plan will not pay any benefits if the primary plan has already paid an amount equal to or exceeding what the secondary plan would have paid on its own.

Navigating Claims with Multiple Plans

Processing dental claims with two insurance plans involves a specific sequence. The first step is to submit the dental claim to the primary insurance plan. This initial submission allows the primary insurer to review the services rendered and pay its portion according to the policy’s terms, including deductibles and copayments.

After the primary insurer processes the claim, an Explanation of Benefits (EOB) is issued. This EOB details the services covered, the amount paid by the primary plan, and any remaining balance. The EOB from the primary insurer is then submitted along with the original claim to the secondary insurance plan. The secondary insurer uses this information to determine its payment responsibility.

The secondary plan reviews the claim and the primary EOB, paying any remaining balance up to its coverage limits or the total allowed amount for the service, considering any non-duplication clauses. It is important to maintain clear communication with both insurance providers and the dental office about your dual coverage status. Keeping thorough records of all EOBs, claim submissions, and correspondence with insurers is also recommended for future reference and dispute resolution.

Key Considerations for Dual Coverage

Evaluating whether having two dental insurance plans is beneficial requires assessing costs versus potential savings. The expense of paying two monthly premiums must be weighed against potentially reduced out-of-pocket expenses for dental care. Dual coverage is not always cost-effective, especially if dental needs are minimal and both plans have similar benefit structures.

Various policy features can influence the overall value of dual coverage. Waiting periods, often 6-12 months for major procedures, apply to each plan independently and can delay access to certain benefits. Each plan also has an annual maximum benefit, often $1,500-$2,000 annually, limiting the total amount an insurer pays yearly. Specific exclusions, such as those related to pre-existing conditions or cosmetic procedures, may also apply to one or both policies.

Dual coverage is most advantageous for individuals or families anticipating extensive dental work, such as orthodontia, multiple crowns, or implants, where the combined benefits can substantially lower personal costs. It is imperative to disclose all insurance coverage to your dental office at the outset. This information ensures that claims are submitted correctly and efficiently, preventing delays and potential issues with benefit coordination.