If You Have Two Dental Plans | MouthHealthy - Oral Health Information from the ADA

What To Do If You Have Two Dental Plans

Two hands protecting a glowing white tooth.

Some patients are covered by two or more dental benefit plans, often a plan from their employer and one from their partner’s employer. So what happens when you’re entitled to additional benefits? A process called coordination of benefits sorts out which plan pays first.

What is COB?

Coordination of benefits (COB) is simply the sorting out of which plan pays what for a patient’s dental care. Benefits from all sources should not exceed 100% of the total charges. When both plans have a COB clause, the plan in which the patient is enrolled as an employee or as the main policy holder is considered the primary plan. The plan in which the patient is enrolled as a dependent would be secondary. Sometimes state laws and regulations determine coordination of benefits, or the plans will coordinate the benefits to avoid overbilling or duplication of benefits.

When Does Secondary Pay?

The secondary plan usually will not accept a claim until after the primary claim is paid. In most cases the secondary policy will require a copy of the primary plan’s payment explanation, commonly referred to as an EOB (explanation of benefits).

Which Plan Pays for Your Children?

The policy that pays first for dependents is decided by the dental plan or state laws, so the primary plan covering your children depends on your state’s regulations. Most plans use the "birthday rule" (the spouse with a birthday occurring earlier in the calendar year is primary). Others may consider the father's plan primary. In the case of divorced/separated parents, a court ruling is the decision maker.