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74 million Americans do not have any dental insurance¹, yet many adults are fortunate enough to be covered by not just one, but two or more dental insurance policies. Though dual dental coverage isn’t very common, it most often occurs when two spouses both receive dental benefits from their employer.
Having multiple dental insurance policies is acceptable. In fact, having more than one dental insurance policy can offer you additional benefits and help you save on out-of-pocket costs. However, having multiple dental insurance policies is not necessary.
You could be covered by more than one dental insurance policy without even knowing it. If both you and your partner enjoy dental benefits from your respective full-time employers, chances are you may both be covered by both policies, as well as your children. If you find this to be the case, you can either compare the costs of premiums, co-pays, deductibles, and coverage options to choose just one employer-sponsored policy to cover your whole family, or keep both policies and enjoy the advantages of dual coverage.
If you are covered by multiple dental insurance policies, you are entitled to additional benefits. However, this does not mean that your combined dental insurance plans will ever pay more than 100% of any procedures you undergo. A process called coordination of benefits (CO) determines which plan pays what for dental care, ensuring that the cumulative insurance benefits are not duplicated and don’t exceed 100% of the total charges. Most plans have a COB clause indicating how benefits will be paid if you have multiple insurance policies. In other cases, state laws and regulations might determine the coordination of benefits or insurance companies might coordinate benefits together.
Dual coverage allows a person to access both insurance plans to cover their dental claim costs. However, dual coverage is not double coverage. If each of your plans cover two cleanings a year, you will only be covered for two cleanings a year – not four. If each of your plans cover preventive care at 100%, you will not have to pay anything out of pocket for the procedure, but you won’t get any extra money put in your pocket either. If each of your plans cover major procedures at 50%, they won’t be covered 100% (though in total, your insurance companies may pay out more than 50% in the end.)
When you are covered by two or more dental insurance plans, you’ll need to designate one insurance plan as your primary plan and one as your secondary plan.
Your primary plan is the plan that will pay out benefits first. Generally, the plan that covers you as the primary account holder will be the primary plan, while the plan which covers you as a dependent will be your secondary plan.
If you are a primary account holder in more than one plan, such as a plan through your employer and a retirement plan, choose the employer-sponsored plan as your primary plan. If you have plans provided by more than one employer, choose the plan that is covered you the longest as the primary plan. If you have dental coverage under both a medical and a dental plan, the medical plan is primary.
As for dependent children who are covered by both parents’ dental plans, the policy that pays first is decided by the dental plan or by state laws. Most plans use the birthday rule, which says the plan belonging to the spouse with a birthday occurring earlier in the calendar year is primary. Others automatically consider the father’s plan primary. If a dependent child’s parents are divorced or separated, a court ruling takes precedence.
Your primary plan pays out any designated benefits as though you had no additional insurance plan. Your secondary plan is supplemental and may cover some remaining out-of-pocket expenses. Secondary plans usually will not accept a claim until after a primary claim has been submitted and paid.
For example, if your primary plan only pays 50% of a procedure while your secondary plan covers 80%, your secondary plan could reduce out of pocket costs. However, the secondary plan’s exact coverage amount will be based on its COB clauses and non-duplication of benefits rules.
Some dental insurance plans have a non-duplication of benefits clause that applies when you have more than one dental insurance plan. This means that if the primary plan already paid the same amount or more than what the secondary plan allows for the same treatment, the secondary plan will not pay out any benefits.
Some dental insurance plans use a maintenance of benefits clause. This reduces covered charges by the amount the primary plan has already paid, then applies the plan deductible and co-insurance criteria.
Other plans use a carve out coordination method. This first calculates the plan benefits that would have been paid, then reduces the amount by the amount already paid by the primary plan.
For example, if both your primary plan and your secondary plan cover 70% of a root canal, you will first submit your bill to your primary plan to receive the 70% reimbursement. You can then opt to submit any remaining balance to your secondary plan – but if your plan is subject to any of the clauses, you may not receive any additional benefits.
Check your secondary policy’s terms to see whether they have a carve out, maintenance of benefits, or non-duplication of benefits clause written in.
If you are covered by two dental insurance policies, your secondary plan may not pay out benefits automatically. You will have to be proactive about submitting claims to receive the benefits you’re entitled to.
Here’s how to use two dental insurance policies to your advantage, step by step:
Submit the claim to your primary provider. First, submit your dental insurance claim to your primary provider, just as you would if you did not have multiple insurance plans. Depending on your provider, this may involve filling out some forms and paperwork. (If you have a Guardian Direct dental insurance plan, you don’t have to fill out any paperwork at all when you visit an in-network dentist.)
Submit the claim to your secondary provider. Once you receive notice that the claim has been accepted and paid, submit the claim to your secondary insurance company. Be sure to include a receipt from the first provider as proof of what’s already been paid.
Be patient & check your policy. Depending on your policy, the secondary insurance company may pay all or part of the remaining balance. Go over the terms of your insurance policy so you have a good idea of what to expect.
Receive your benefits. If your secondary provider approves the claim, you’ll receive reimbursement for some or all your out-of-pocket expenses associated with the procedure.
While it isn’t necessary to have multiple dental insurance policies, having dual dental coverage can offer various benefits to you and your family. But that doesn’t mean it’s without drawbacks. Here are a few pros and cons to consider as you’re deciding whether to keep multiple dental insurance policies or just stick with one.
Saves on out-of-pocket costs. Dual coverage can allow you to save even more than you might if you only had one insurance plan.
More coverage. Having multiple dental insurance policies can offer you more coverage in case you or a dependent need a major procedure done. Plus, having more than one plan will allow you to avoid any gaps in coverage in case you or your spouse leaves their job.
Reduces financial stress. If a dental issue arises, it is better to be over-covered than under-covered. Having two or more dental insurance plans can allow you to worry less.
Unnecessary expense. Many dental insurance policies are comprehensive enough on their own. You might be better off choosing just one policy, especially if your employer charges a premium to cover dependents.
Can be difficult to navigate. Coordination of benefits can get complicated – and submitting all your claims twice can be a hassle. It is usually simpler to stick with just one insurance policy.
Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care, and even experience greater overall health.²
However, you do not need more than one dental insurance policy. It is possible to enjoy the benefits of dental insurance with just one high-quality policy.
Having multiple dental insurance policies can be a bit complicated. But if you are fortunate enough to enjoy dual coverage, being proactive about taking advantage of your benefits can pay off in a big way. You may save on out-of-pocket costs, you will avoid lapses in coverage, and you’ll know you’re covered in the case of a dental emergency.
If you do not have multiple dental insurance policies, don’t worry. As long as you find a high-quality dental insurance plan with plenty of coverage and benefits, you can still save money and enjoy all of the advantages of having dental insurance. Though you can have multiple dental insurance policies, you should be adequately covered if you have one.
Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.
Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.06/22)
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