Individual and Family Dental Insurance
Dental Insurance is one of the most requested benefits. For most, dental procedures are a necessary evil. Lucky are those that have never experienced the stress of the waiting room and the shock of the subsequent bill! However, everyone must visit the dentist’s office at one time or another.
Quite often, dental coverage is included in one’s work benefits package. If a plan is available, it is best to learn if there a several choices of dental plans. Most dental insurance plans cover a maximum of $1000 to $2000 of dental services per year. Any additional dental services must be paid out of pocket.
If a dental insurance plan is not provided by one’s employer, it is advisable to purchase an Individual Dental Insurance policy.
Basic dental insurance coverage falls into three major categories:
Preventive and Diagnostic Dental Care
Nearly all dental insurance policies cover basic dental services such as checkups, x-rays, cleanings, as well as other basic procedures that help prevent tooth and gum disease. Since regular dental care prevents more serious, potential problems, this coverage is very important.
Basic Dental Care and Dental Procedures
Basic dental procedures include fillings, repair of chipped teeth, tooth extractions, periodontal treatment, root canals, etc. However, with some dental insurance providers, some procedures can not be listed as basics. These may include, for example, root canals. One must select a dental insurance provider that covers the most basic dental care and dental procedures.
Major Dental Care
Major dental care usually includes dental surgery, denture work, orthodontics, and other serious expensive dental procedures. Some dental insurance plans cover a portion of major dental care costs.
Types of Dental Plans
Dental insurance plans are contracts between the sponsor (an employer or organization) and the third party (an insurance company), according to which you can arrange dental treatment into the most suitable configuration. Often, dental insurance plans do not cover the full cost of dental care. Programs have some provisions that limit the amount the insurance company will pay. Common methods of payment limitations are deductibles, co-payments, and dollar limits. All limitations in dental coverage are stated in the dental insurance policy. These limitations are the result of an agreement between the sponsor and the third-party. An average dental insurance plan will cover 100% of preventive measures, 80% of basic dental work and 50% for major procedures.
The various types of dental insurance plans may cover the most basic dental care to complete, all encompassing dental procedures. Indemnity, Dental Health Maintenance Organization (DHMO) and Preferred Provider Organization (PPO) managed care programs are the basic plan types.
Indemnity dental insurance plans require the insured to pay the insurance company a monthly fee–approximately $14 – $26–while the insurance company agrees to pay the dentist for dental services. The policyholder is usually liable for 20%-50% of the service costs.
Dental Health Maintenance Organization (DHMO)
DHMO is a pre-paid dental care plan in which a fixed monthly fee from the DHMO goes to a participating dentist for each patient assigned to the respective dentist. The policyholder may be required to contribute to the cost of treatment. These insurance plans normally deal with preventative and emergency care, thus varying from patient to patient.
Preferred Provider Organization (PPO)
According to PPO insurance plans, one can choose to visit dentists from a preferred supplier list at a substantial discount. On this plan, the policyholder may pay approximately $25 per month. A lesser discount is available for treatments provided by a dentist not covered by the plan.
Point of Service Plan (POS)
POS is a managed care plan through which a patient can receive treatment from a non-participating dentist at lower benefit levels.
Direct Reimbursement (DR)
Using a DR dental plan, one can choose any dentist and treatment plan. The patient must submit receipts to his/her employer for reimbursement. DR is a straightforward plan that allows employees to avoid the complexity of lists, deductibles and paperwork. However, this plan is often too costly for most small businesses.
Understanding dental insurance is important for one’s health and budget. Be aware of what is covered and what is excluded, as well as the out-of-pocket costs and the lead time before coverage begins. Most plans do not cover dental treatment provided solely for cosmetic improvements, as well as hospitalization.
A dentist can provide the necessary information for a patient to prepare a claim, or the dentist may file the claim. Dental insurance coverage will reduce dental expenses.