How Does Having Two Dental Insurances Work?

Having two dental insurance plans can raise questions about how benefits are applied. Individuals often have dual dental coverage through various circumstances, such as employment benefits or a spouse’s plan. Understanding how these plans interact is important for maximizing coverage and managing dental care expenses.

Coordination of Benefits Explained

Coordination of Benefits (COB) is the process insurance companies use to determine how claims are paid when an individual has coverage under more than one dental plan. Its primary purpose is to prevent individuals from receiving total benefits that exceed 100% of the actual cost of dental services. These rules ensure plans work together to eliminate over-insurance or duplication of benefits.

These rules define the order in which each plan pays its portion of dental expenses. Group (employer) plans are generally required to coordinate benefits, while individual policies may not always have this provision. The coordination process ensures that combined payments from all plans do not exceed the total allowed charge for the dental procedure.

Identifying Your Primary and Secondary Plans

Determining which dental plan is primary and which is secondary is a key step in navigating dual coverage. The primary plan generally pays first, and after its benefits are applied, the secondary plan may cover remaining eligible costs. Various common rules dictate this order, ensuring a standardized approach across the insurance industry.

For adults, the plan where you are enrolled as the employee or main policyholder is typically primary over a plan where you are covered as a dependent. If you are the subscriber on two plans, the plan with the longest coverage duration is often primary. For children covered by both parents’ plans, the “Birthday Rule” usually applies: the plan of the parent whose birthday falls earlier in the calendar year is primary, regardless of birth year. A court order in cases of divorced or separated parents can override the Birthday Rule. When an individual has coverage through current employment and also through a COBRA or retiree plan, the active employment plan is generally primary.

Submitting Claims with Two Insurers

The process of submitting claims with dual dental insurance begins with the primary insurer. This initial submission allows the primary plan to apply its benefits, deductibles, and co-insurance according to its policy terms. After the primary plan processes the claim, the secondary plan then assesses the remaining balance.

Once the primary insurer has processed the claim, they will issue an Explanation of Benefits (EOB) document. This EOB details what the primary plan paid, any amounts adjusted, and the remaining patient responsibility. To engage the secondary plan, a copy of this EOB, along with the original claim information, is then submitted to the secondary insurer. Dental providers often handle this submission process on behalf of the patient, though individuals may also submit claims directly.

How Multiple Plans Affect Your Costs

Having multiple dental plans generally leads to a reduction in out-of-pocket expenses for covered dental procedures. While dual coverage does not mean you receive double benefits, it allows the costs of approved treatments to be shared between the two insurance providers. The primary plan pays its portion first, and then the secondary plan may cover some of the remaining balance, potentially including deductibles, co-pays, or amounts exceeding the primary plan’s limits.

For example, if a procedure costs $1,000 and the primary plan covers 80% after a deductible, the secondary plan might then cover a portion of the remaining 20% or even the deductible itself, depending on its terms. This coordination can significantly reduce the amount you pay out-of-pocket, especially for more extensive or costly treatments like orthodontics or implants.

Different Situations for Dual Coverage

Dual dental coverage arises in several common scenarios, illustrating the practical application of primary and secondary plan rules. One frequent situation involves a person covered by their own employer’s dental plan who is also included as a dependent on their spouse’s plan. In this instance, the individual’s own employer-sponsored plan is typically primary for their dental care, and the spouse’s plan acts as the secondary coverage.

Another common scenario involves children covered under both parents’ dental insurance plans, where the “Birthday Rule” usually applies to determine primary coverage. A third situation might occur when someone leaves a job and maintains temporary COBRA coverage while also gaining new dental benefits from a new employer. In this case, the plan from the new employer is generally primary, and the COBRA plan would be secondary. These examples demonstrate how dual coverage can provide additional financial support for dental care needs.