Can You Use Multiple Dental Insurance?

When individuals have access to more than one dental insurance plan, questions often arise about how these plans interact and provide coverage. This frequently occurs through an individual’s own employer, a spouse’s employer, or a privately purchased plan. Understanding how multiple dental policies coordinate benefits can clarify how coverage applies to dental services.

The Possibility of Multiple Dental Plans

It is possible for an individual to be covered by more than one dental insurance plan simultaneously. This often arises when an individual has coverage through their own employer and is also a dependent on a spouse’s employer-sponsored plan. Another instance involves holding a private dental plan in addition to an employer-provided one.

While having multiple plans is permissible, dental benefits are not simply doubled. Instead, a specific process determines how these different plans work together to cover dental procedure costs. This coordination ensures claims are processed efficiently and helps manage how benefits apply across policies, preventing overpayment for services.

Coordination of Benefits Explained

Coordination of Benefits (COB) governs how multiple dental insurance policies interact. This mechanism prevents policyholders from receiving more than 100% of the cost of their dental care when covered by multiple plans. COB ensures the total amount paid by all involved insurers does not exceed the total charges for dental services.

COB rules establish an orderly process for claims payment, ensuring fair cost distribution among insurance providers. These rules are standard across the insurance industry and are often mandated by state laws. By coordinating benefits, insurers determine their respective responsibilities, which helps manage the financial aspects of dental treatment when multiple coverages are in place.

Determining Primary and Secondary Insurance

Coordination of Benefits involves determining which dental insurance plan is “primary” and which is “secondary.” The primary plan pays benefits first, according to its terms, deductibles, and annual maximums. Once the primary plan processes the claim, the secondary plan considers the remaining balance.

Common rules dictate this hierarchy. The plan covering the patient as an active employee or main policyholder is generally primary. If an individual has coverage through their own employer and as a dependent on a spouse’s plan, their own employer’s plan is primary. For dependent children covered by both parents’ plans, the “birthday rule” often applies, making the plan of the parent whose birthday falls earlier in the calendar year primary. In cases of divorced or separated parents, a court decree regarding healthcare expenses takes precedence.

Submitting Claims with Multiple Plans

When an individual has both primary and secondary dental insurance, the claim submission process follows a specific order. First, submit the dental claim to the primary insurance provider. This plan processes the claim based on its policy terms, applying any deductibles, copayments, and benefit percentages.

After the primary plan processes the claim, it issues an Explanation of Benefits (EOB). This document details what the primary plan paid, what was covered, and any remaining balance. The EOB from the primary insurer is then submitted to the secondary insurance provider, along with the original claim for the remaining charges. Some dental offices may assist patients by handling this coordination directly.

Understanding Your Combined Coverage

When two dental plans coordinate benefits, the primary plan pays first, applying its specific benefits, deductibles, and annual maximums. An annual maximum is the maximum dollar amount a dental insurance plan will pay toward the cost of dental services in a benefit period, typically 12 months, often ranging between $1,000 and $2,000. The secondary plan then reviews the remaining balance.

The secondary plan processes the claim, paying up to its own benefit limits, but not exceeding the amount it would have paid had it been the primary insurer. The combined payments from both plans will not exceed 100% of the total cost of the dental service. This coordination can significantly reduce out-of-pocket expenses for the policyholder, but it does not imply “double” coverage or receiving more than the actual cost of treatment.