Can You Use Two Insurances for Dental?

It is possible to have coverage from two dental insurance plans simultaneously. This arrangement is commonly referred to as dual dental coverage. When an individual is covered by more than one dental plan, a process called Coordination of Benefits (COB) is used to determine how the plans work together to pay for services. This ensures combined payments from all plans do not exceed the total treatment cost.

Coordination of Benefits Explained

Coordination of Benefits (COB) is the standard process insurance companies use to prevent overpayment and fairly distribute costs when a person has multiple dental plans. It outlines which plan is primary and which is secondary. The primary plan pays benefits first, and the secondary plan considers any remaining balance.

Determining the primary plan typically follows specific guidelines. If an individual has coverage through their own employer and also as a dependent on another plan, their own employer-sponsored plan is generally designated as primary. When a person has two dental plans through different employers, the plan that has covered them longest is usually primary. A plan from current employment takes precedence over a COBRA or retiree plan. If a dental procedure could potentially be covered by both a medical and a dental plan, such as certain oral surgeries, the medical plan typically acts as the primary payer.

For dependent children covered by both parents’ dental plans, the “Birthday Rule” often applies to determine the primary insurer. This rule designates the plan of the parent whose birthday falls earlier in the calendar year (month and day only) as primary. However, exceptions exist; a court order or divorce decree specifying dental coverage responsibility overrides the Birthday Rule. If both parents share the same birthday, the plan active for the dependent longer typically becomes primary.

Some dental plans include a “non-duplication of benefits” clause, particularly common in self-funded plans. This clause stipulates that if the primary plan pays an amount equal to or greater than what the secondary plan would have paid, the secondary plan will not make additional payment. This can result in higher out-of-pocket costs for the patient compared to traditional COB arrangements. In most cases without a non-duplication clause, the secondary plan pays a supplemental amount after the primary plan has processed the claim, ensuring the combined payment does not exceed the total allowed charge for the service.

Situations Leading to Dual Coverage

Several common scenarios can lead an individual to have two dental insurance plans. One frequent situation occurs when an individual is covered by their own employer’s dental plan and is also included as a dependent on their spouse’s employer-sponsored dental plan. In such instances, both plans provide coverage, necessitating coordination of benefits. This provides an additional layer of potential coverage for dental expenses.

Another scenario involves individuals who hold two jobs, where both employers offer dental benefits. Since each employer provides a separate dental plan, the individual ends up with dual coverage. This can also happen if someone transitions from one job to another and maintains coverage from their former employer, such as a retiree plan, while also enrolling in their new employer’s plan. These situations automatically create an environment where two plans are active for the same person.

Dependent children are frequently covered by dual dental plans. This typically arises when both parents have separate dental insurance policies through their respective employers, and each policy includes the child as a dependent. The interplay of these two plans then falls under the established Coordination of Benefits rules. Additionally, an individual might intentionally acquire a supplemental dental plan to augment their existing employer-provided coverage, seeking broader benefits or lower out-of-pocket costs.

Navigating Claims with Multiple Plans

When an individual has multiple dental insurance plans, the process of submitting claims requires specific steps to ensure proper payment. The dental office typically initiates the claim by submitting it directly to the patient’s primary insurance carrier. This initial submission includes all necessary details about the performed procedure and the patient’s coverage information.

After the primary insurer processes the claim, they will issue an Explanation of Benefits (EOB) statement. This document is not a bill but provides a detailed breakdown of the services rendered, the amount the primary plan paid, and any remaining balance that is the patient’s responsibility. The EOB is a crucial record for understanding how the primary plan applied its benefits, including any deductibles or co-payments.

To utilize the secondary insurance, the EOB from the primary plan is essential. The dental office or the patient then submits a claim to the secondary insurer, typically attaching a copy of the primary EOB. The secondary plan then reviews the claim in conjunction with the primary EOB to determine its payment, applying its own benefits and Coordination of Benefits rules. The goal is for the secondary plan to cover additional costs up to its policy limits, after the primary plan has paid.

Maintaining clear communication with both insurance companies and the dental office is important throughout this process. Before treatment, it is advisable to confirm eligibility and understand how both plans will coordinate for specific procedures. Ensuring all patient demographic information and procedure codes are accurate on claim forms can help prevent delays or denials in payment.