How Does Double Dental Insurance Work?
Learn how dual dental insurance plans coordinate to optimize your benefits and manage dental care costs.
Having more than one dental insurance plan, known as dual dental coverage, offers financial advantages for managing dental care expenses. While benefits do not simply double, these plans interact to ensure fair coverage without overpayment. Understanding how these multiple plans work together can help individuals navigate their dental benefits effectively and potentially reduce out-of-pocket costs.
Understanding Multiple Dental Insurance Plans
Dual dental coverage occurs when an individual is enrolled in two separate dental insurance plans. This is common in several scenarios. For instance, an individual might have coverage through their own employer and also as a dependent under a spouse’s plan. Children are frequently covered by both parents’ dental plans. Another situation involves an individual working two jobs, both offering dental benefits.
While two plans do not mean receiving double the benefits, they can lead to reduced out-of-pocket expenses for covered dental procedures. Multiple plans use a structured approach to determine how each contributes to the cost of care. This interaction ensures the total amount paid by both plans does not exceed the total cost of services received.
How Coordination of Benefits Works
When an individual has dual dental coverage, Coordination of Benefits (COB) rules determine which plan pays first and how much each contributes. COB prevents overpayment or duplication of benefits, ensuring combined payouts do not exceed the dental provider’s fee. One plan is designated as the primary insurer, and the other as the secondary. The primary plan processes the claim first, and any remaining balance is submitted to the secondary plan.
Various rules determine which plan is primary. The plan covering the individual as an employee or main policyholder is primary, while a plan covering them as a dependent is secondary. If an individual has coverage from two employers, the plan that has covered them for the longest duration becomes primary. For dependent children, the “Birthday Rule” applies: the plan of the parent whose birthday falls earlier in the calendar year is primary. In cases of divorced or separated parents, a court decree specifying financial responsibility for dental care can override the Birthday Rule.
After the primary plan pays its portion, the secondary plan reviews the remaining balance. The secondary plan may then cover additional costs, potentially reducing the patient’s out-of-pocket expenses, such as deductibles, copayments, and coinsurance. Some secondary plans include a “non-duplication of benefits” clause. This means they will not pay benefits if the primary plan has already paid an amount equal to or more than what the secondary plan would have paid as primary. The combined benefits from both plans cannot exceed the total amount the dentist has agreed to accept as the total allowed charge.
Submitting Claims with Dual Coverage
The process of submitting claims with dual dental coverage begins with the dental office. When a patient has two active dental plans, the dental office handles the initial submission to the primary insurance carrier. After the primary insurer processes the claim and determines its payment, an Explanation of Benefits (EOB) is generated. This EOB details the services rendered, the amount the primary plan covered, and any remaining balance that is the patient’s responsibility.
Once the primary EOB is received, the dental office then submits the claim, along with a copy of the primary EOB, to the secondary insurance carrier. The secondary plan reviews the claim and the primary’s EOB to determine its payment based on its own coordination of benefits rules. Patients should ensure their dental provider has accurate and complete information for both insurance plans, including policy numbers and group numbers, to facilitate this process. While the dental office often manages these submissions, patients should understand the sequence and review EOBs from both insurers to verify how benefits were applied and to understand their remaining financial obligation.