Can You Have Two Dental Plans With the Same Company?

Dental insurance helps manage the costs of oral health care. It covers routine cleanings, examinations, and more extensive procedures like fillings or extractions. Dental coverage is a valuable component of personal financial planning, as good oral health connects to overall well-being. It ensures access to preventive care, which can identify and address issues before they escalate into costly problems.

Can You Have Two Plans from the Same Company?

It is generally possible to have two dental plans, a situation often referred to as dual dental coverage. This can occur even if both plans are from the same insurance company, as they are typically treated as separate policies. Dual coverage does not mean benefits are doubled, but rather that the two plans coordinate to cover costs.

Common scenarios leading to dual coverage include having two benefit-eligible jobs, or when an individual has their own employer-sponsored coverage and is also covered as a dependent under a spouse’s employer plan. For instance, if both you and your spouse have dental benefits through your respective employers, and your spouse’s plan also covers you, you would have dual coverage. Even when both plans are under the same carrier, coordination of benefits still applies to determine how claims are processed.

Coordination of Benefits Explained

Coordination of Benefits (COB) is a procedure used when a patient is entitled to benefits from more than one dental plan. Its primary purpose is to prevent “over-insurance,” ensuring combined payments from multiple plans do not exceed 100% of the actual cost of dental services.

When dual coverage exists, one plan is designated as primary, and the other as secondary. The primary plan pays its benefits first, as if no other insurance exists. After the primary plan has paid, the secondary plan may then contribute to the remaining costs, up to its own coverage limits.

Determining Primary and Secondary Coverage

Specific rules and common practices dictate which dental plan is considered primary and which is secondary. For an individual, the plan in which they are enrolled as an employee or main policyholder is primary. If an individual has two jobs, the plan from the employer that has covered the patient the longest is designated as primary.

For dependent children, the “birthday rule” is a widely accepted guideline. This rule specifies that the plan of the parent whose birthday falls earlier in the calendar year (month and day) is primary. In situations involving divorced or separated parents, a court decree specifying financial responsibility for the child’s dental care takes precedence. If a dependent has their own policy, such as a college student, their individual plan becomes primary, with parental coverage serving as secondary.

Navigating Dual Coverage

Individuals with dual dental coverage can reduce their out-of-pocket costs for dental procedures. While dual coverage helps manage expenses, it does not mean 100% free dental care. Patients remain responsible for any applicable deductibles, co-payments, or amounts exceeding annual or lifetime maximums.

When a dental service is rendered, the claim is first submitted to the primary insurance carrier. After the primary carrier processes the claim and pays its portion, the remaining balance is submitted to the secondary carrier, often with the Explanation of Benefits (EOB) from the primary plan. An EOB is a statement from the insurance company detailing services received, amounts covered, and the patient’s responsibility. Understanding these EOBs is important for verifying payments and knowing what is still owed.