Can You Use 2 Insurance Plans for Dental?

Dual dental coverage means having two dental insurance plans simultaneously. This scenario 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. While having two plans does not typically result in receiving double the benefits, it can often lead to reduced out-of-pocket expenses for covered dental procedures. This arrangement coordinates payments between carriers for comprehensive coverage.

Coordination of Benefits

Coordination of Benefits (COB) is a system insurance companies use when an individual has more than one dental plan. COB is a set of rules that determines how two or more dental plans will work together to pay for dental services. The primary purpose of COB is to prevent overpayment or the duplication of benefits, ensuring that the combined payout from both plans does not exceed the total cost of the dental service.

Under COB, one plan is designated as the primary insurer, which pays its portion of the claim first. After the primary plan has processed the claim, the secondary plan then considers the remaining balance. This coordination helps to distribute the financial responsibility for dental care between the multiple plans, potentially reducing the patient’s financial burden.

Identifying Primary and Secondary Plans

Identifying the primary and secondary dental plans is crucial for effective dual coverage. For individuals covered by their own employer’s plan and a spouse’s plan, their own employer-sponsored plan is typically primary. The plan through their spouse’s employer would then be considered secondary coverage for that individual.

For children covered under both parents’ dental plans, the “Birthday Rule” is a common guideline used to establish primary coverage. Under this rule, the plan of the parent whose birthday falls earlier in the calendar year is typically considered primary, regardless of the birth year. If a patient has two jobs and is enrolled in benefits packages at both, the plan they enrolled in first is often deemed primary. Additionally, a plan from active employment is generally primary over a COBRA or retired plan.

Claim Submission with Dual Coverage

Submitting dental claims with dual coverage follows a specific sequence. Initially, the dental claim should be submitted to the primary insurance carrier. This allows the primary plan to process the claim according to its benefits and pay its allocated portion.

After the primary carrier has processed the claim, an Explanation of Benefits (EOB) document will be issued, detailing what the primary plan paid and any remaining balance. This EOB is essential for the next step, as the claim for the remaining balance is submitted to the secondary insurance carrier. The EOB from the primary plan should be included with the secondary claim submission to provide necessary information regarding the initial payment.

Financial Outcomes of Multiple Plans

Having two dental insurance plans does not mean that the total dental bill will be covered twice or that you will receive double benefits. Instead, the combined payments from both plans are typically capped at 100% of the allowed amount for the dental service. The “allowed amount” represents the maximum fee an insurance company will consider for a specific procedure.

Deductibles and copayments, which are out-of-pocket costs, still apply with dual coverage. While the secondary plan might help reduce or even eliminate these costs after the primary plan has paid, they are not automatically waived. Some plans may also include a “non-duplication of benefits” clause, which means the secondary plan may not pay anything if the primary plan has already paid as much or more than the secondary plan would have paid on its own. Furthermore, each dental plan generally has its own annual maximum benefit, and having dual coverage does not necessarily double the total annual payout available to the patient.