Can You Use 2 Dental Insurance Plans?

It is common for individuals to have more than one dental insurance policy, often through an employer, a spouse’s employer, or an individual plan. While this might seem like double coverage, a structured process dictates how these plans work together. Understanding this process helps individuals maximize benefits and manage dental care expenses.

Understanding Coordination of Benefits

When an individual has more than one dental insurance plan, Coordination of Benefits (COB) ensures total benefits paid do not exceed 100% of the dental service cost. This prevents “over-insurance” or “duplication of benefits.”

COB designates dental plans as “primary” or “secondary.” The primary plan pays first, without considering other coverage. After the primary plan processes a claim, the secondary plan reviews the remaining balance. This structured approach ensures an orderly payment sequence.

Some dental plans include a “non-duplication of benefits” clause. This clause states that if the primary plan pays an amount equal to or more than what the secondary plan would have paid as primary, the secondary plan may not pay additional benefits. These provisions, often in self-funded plans, can lead to higher out-of-pocket costs.

Determining Primary and Secondary Plans

Identifying primary and secondary dental plans is important for using multiple coverages. Insurance companies follow specific rules. Generally, the plan covering an individual as an employee or main policyholder is primary. A plan covering the individual as a dependent, such as through a spouse, is typically secondary.

For dependent children covered by both parents’ plans, the “birthday rule” applies. The plan of the parent whose birthday occurs earlier in the calendar year (month and day) is primary. For example, if one parent’s birthday is in March and the other’s in July, the March birthday plan is primary. Court orders specifying responsibility for dental expenses take precedence over this rule.

If an individual has coverage through multiple employers, the plan covering them longest is usually primary. If a person has current employment and a retiree or COBRA plan, the current employment plan is typically primary. For procedures covered by both medical and dental plans, like some oral surgeries, the medical plan is generally primary.

Processing Claims with Multiple Plans

After identifying primary and secondary dental plans, submit the claim to the primary insurance provider first. This allows the primary plan to process the claim based on its policy terms, deductibles, and coverage limits.

After processing, the primary insurer issues an Explanation of Benefits (EOB). This document details services covered, amounts paid, deductible application, and the remaining balance. The EOB is necessary for the secondary insurer to understand what has been covered.

Next, submit the claim to the secondary dental plan, typically with a copy of the primary plan’s EOB and original claim information. The secondary insurer reviews the remaining balance to determine their coverage, based on their policy and COB provisions. The goal is to reduce the patient’s out-of-pocket costs, potentially covering a significant portion of the balance without exceeding the total procedure cost.

Specific Scenarios for Dual Coverage

Dual dental coverage effectiveness varies by plan type and policy clauses. Traditional dental insurance differs from dental discount plans. Discount plans are not insurance; they offer reduced rates from network dentists for an annual fee. They do not involve claims processing or COB, providing only a discount at service.

Managed care plans interact uniquely with COB. Preferred Provider Organizations (PPOs) offer flexibility, allowing choice of any dentist, with greater savings in-network. PPOs typically have deductibles and annual maximums. Dental Health Maintenance Organizations (DHMOs) usually require selecting a primary dental facility and referrals for specialists, offering lower out-of-pocket costs and often no annual maximums or deductibles. COB with DHMOs may be limited by their restrictive network requirements.

Specific clauses in insurance policies influence dual coverage. The “non-duplication of benefits” clause, mentioned earlier, can significantly impact secondary plan payments. This clause may result in the secondary insurer paying nothing if the primary plan’s payment meets or exceeds what the secondary plan would have paid as primary. Understanding these distinctions helps patients maximize dental benefits.