Can You Have Two Dental Plans at the Same Time?

It is common for individuals to wonder whether it is possible to have more than one dental insurance plan at the same time. This inquiry often arises due to changes in employment, a spouse’s benefits, or when considering supplementing existing coverage. Understanding how multiple dental plans interact is important for managing healthcare expenses effectively. This article will clarify the concept of dual dental coverage and explain how benefits are coordinated when more than one plan is in effect.

Understanding Dual Dental Coverage

Dual dental coverage refers to a situation where an individual is covered by two separate dental insurance policies concurrently. This typically happens when someone has a dental plan through their own employer and is also covered as a dependent under a spouse’s or partner’s dental plan. Another common scenario involves a person having an employer-sponsored plan while also purchasing an individual dental policy.

While having dual coverage can offer broader access to dental care, it does not mean that all services will be paid for twice. Instead, the two plans work together through a process called coordination of benefits. This coordination ensures that the total amount paid by both plans does not exceed the actual cost of the dental procedure, preventing individuals from profiting from their coverage.

How Coordination of Benefits Works

Coordination of Benefits (COB) is the process by which two or more dental insurance plans determine their respective responsibilities for paying dental claims. This process ensures that the combined payments from all plans do not surpass 100% of the total treatment cost. Each dental plan has specific rules for how it coordinates benefits with other coverages.

A primary plan is identified first, which pays its benefits as if no other coverage exists. The secondary plan then reviews the remaining balance after the primary plan has paid, and it may cover some or all of the remaining cost, up to its own maximum allowable amount. For children covered under both parents’ plans, the “Birthday Rule” commonly determines the primary plan: the plan of the parent whose birthday falls earlier in the calendar year is usually considered primary.

Two common methods for coordinating benefits are “Non-Duplication of Benefits” and “Maintenance of Benefits,” also known as “Carve-Out.” Under Non-Duplication, the secondary plan may 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 primary. This method limits the total payout to the higher of the two plans’ benefit levels. The Maintenance of Benefits or Carve-Out method allows the secondary plan to calculate its payment as if it were primary, and then subtract the amount the primary plan paid. This approach often results in a higher combined payment, potentially covering more of the total cost.

Submitting Claims with Multiple Plans

When you have dual dental coverage, the process for submitting claims involves a specific sequence to ensure proper benefit coordination. The initial step is to submit the dental claim to your primary insurance provider. Your dental office typically handles this submission electronically, providing all necessary procedure codes and costs.

After the primary insurance processes the claim, they will issue an Explanation of Benefits (EOB) statement. This document details what the primary plan paid and any remaining balance. Once you receive the EOB from your primary insurer, you or your dental office will then submit the claim, along with the primary EOB, to your secondary insurance provider. The secondary plan uses this information to determine its payment responsibility based on its own coordination of benefits rules.

Provide accurate information to both insurance companies, including details about your other coverage. This allows the plans to coordinate effectively and prevent delays. Keeping copies of all submitted claims and EOBs from both plans can help you track payments and understand your financial responsibility.

Common Dual Coverage Scenarios

Dual dental coverage frequently arises in various family and employment situations. In a spousal coverage scenario, both partners might have employer-sponsored dental plans, and each partner also covers the other as a dependent. An individual’s own employer-sponsored plan typically acts as the primary payer for their dental services.

When children are covered under both parents’ separate dental plans, the Birthday Rule usually determines which parent’s plan is primary for the child’s care. For example, if one parent’s birthday is in April and the other’s is in September, the plan of the parent with the April birthday would generally be the primary insurer. This rule simplifies the determination of primary coverage for dependents.

Another common situation involves an individual who has an employer-provided dental plan but also purchases a separate individual dental plan. In such cases, the employer-sponsored plan is almost always considered the primary coverage. The individually purchased plan would then act as the secondary coverage, potentially covering additional costs that the primary plan did not.