Can you have two dental insurances at the same time?

Dental insurance helps manage the costs of oral healthcare. Many individuals wonder if they can have multiple dental insurance policies simultaneously to enhance their coverage. Understanding how multiple dental plans interact is important for effective financial planning related to dental care.

Having More Than One Dental Insurance Plan

It is possible to have more than one dental insurance plan at the same time, often called dual dental coverage. This commonly arises when an individual has dental benefits through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Other instances include holding two jobs where both employers offer benefits, or supplementing an employer-provided plan with a private policy.

While dual dental coverage is permissible, it does not mean all dental services will be paid for twice, nor does it guarantee full coverage for every procedure. Insurance companies coordinate benefits to prevent overpayment, ensuring total reimbursement does not exceed the actual cost of services. The aim is to reduce out-of-pocket expenses for the insured, not to provide a profit. Ultimately, benefit application depends on the specific terms and conditions of each policy.

Coordination of Benefits (COB)

Coordination of Benefits (COB) is the process by which multiple dental insurance companies determine which plan pays first and how much each plan will contribute when an individual has dual coverage. This process prevents over-insurance, ensuring combined payments do not exceed the total cost of services. One dental plan is designated as the primary payer, responsible for processing the claim first, and the other becomes the secondary payer.

Primary and secondary plans follow specific rules. Typically, the plan covering an individual as an employee or main policyholder is primary. A plan covering an individual as a dependent is generally secondary. For dependent children, the “birthday rule” often applies, meaning the plan of the parent whose birthday falls earlier in the calendar year is primary. Some plans may have different rules, and state laws can influence these determinations.

COB provisions can vary, impacting how much the secondary plan might pay. Under a non-duplication of benefits clause, if the primary plan’s payment equals or exceeds the amount the secondary plan would have paid as primary, the secondary plan may pay nothing. Other COB methods, such as a traditional COB, may allow the secondary plan to cover a portion of the remaining balance, reducing out-of-pocket costs. Only group (employer) plans are generally required to coordinate benefits; individual policies typically do not.

Submitting Claims with Multiple Plans

When an individual has two dental insurance plans, submitting claims involves a specific sequence to ensure proper benefit coordination. The initial step requires submitting the claim to the primary insurance provider. This plan processes the claim based on its policy terms and then issues an Explanation of Benefits (EOB) document.

After receiving the EOB from the primary insurer, this document, along with the original claim form, must then be submitted to the secondary dental insurance provider. The EOB details what the primary plan paid and any remaining balance, which the secondary plan will then evaluate for potential coverage. Include the policy numbers for both plans on the claim forms. Keeping thorough records of all submissions, EOBs, and communications with both insurance carriers helps manage the process effectively.

Factors to Evaluate Before Enrolling in Multiple Plans

Before deciding to maintain or enroll in multiple dental insurance plans, evaluate several key factors to determine the financial and practical advantages. One important consideration is comparing the cost of premiums for both plans against the potential additional benefits received. While dual coverage can reduce out-of-pocket expenses, the combined premiums should not outweigh the supplementary coverage.

Understanding the specifics of each policy, such as annual maximums, deductibles, and waiting periods, is also important. Most dental plans have an annual maximum, typically ranging from $1,000 to $2,000 per year, which is the total amount the plan will pay for covered services within a benefit period. Deductibles, often between $50 and $100 annually, must be met before the plan begins to pay for services. Many plans include waiting periods, especially for basic procedures (e.g., 3-6 months) and major work (e.g., 6-12 months), before coverage for these services becomes active. Investigate the specific COB clauses within each policy and inquire about network access, as some plans may offer broader provider choices or cover services not included in the primary plan.