Can You Have Two Dental Plans & How Do They Work?

Many people wonder if they can manage their dental care costs more effectively by having coverage from more than one dental insurance plan. Understanding how dental plans interact is important for ensuring comprehensive coverage and managing out-of-pocket expenses.

Having Multiple Dental Plans

It is generally permissible to have more than one dental insurance plan, often referred to as dual dental coverage. This can occur through several common scenarios, such as an individual having coverage from their own employer and also being covered as a dependent under a spouse’s employer-sponsored dental plan. Children may also be covered under both parents’ separate employer plans. Additionally, a person might maintain a primary dental plan through their employer and purchase a separate individual dental plan to supplement their coverage. Dual coverage does not mean benefits are automatically doubled, but it can help reduce overall out-of-pocket costs for dental treatments.

How Plans Work Together: Coordination of Benefits

When an individual has more than one dental plan, the process by which these plans interact to cover costs is known as Coordination of Benefits (COB). The purpose of COB is to ensure that the total amount paid by all plans does not exceed the actual cost of services, preventing over-reimbursement.

Under COB, one dental plan is designated as the primary payer, and the other acts as the secondary payer. The primary plan processes and pays its portion of the claim first, according to its specific terms and benefits. After the primary plan has paid, the remaining eligible costs are then submitted to the secondary plan. The secondary plan may then cover some or all of the remaining balance, up to its own coverage limits. It is important to note that COB provisions are typically mandated for group (employer) plans, while individual dental policies are generally not required to coordinate benefits.

Determining Primary and Secondary Coverage

Insurance companies follow specific rules and guidelines to determine which dental plan is primary and which is secondary. For children covered under both parents’ dental plans, the “Birthday Rule” is commonly applied. This rule designates the plan of the parent whose birthday falls earlier in the calendar year (month and day) as the primary plan.

When an individual has coverage through their own employer and is also covered as a dependent on a spouse’s plan, their own employer-sponsored plan is typically considered primary. The spouse’s plan would then serve as the secondary coverage.

If a person has dental coverage as an active employee and also through a retiree or COBRA plan, the active employee plan is usually primary. In situations where an individual has coverage from two different employers, the plan that has covered the individual for the longest duration often becomes the primary plan.