Dental insurance
Dental insurance works like most health insurance. You can choose from HMO, PPO, or POS. You pay a monthly premium for coverage, and the policy pays for all or most of your related costs. The more expensive the policy, the more extensive the coverage. It usually provides regular oral exams, cleanings, x-rays, and other preventive care. Some dental insurance plans even offer coverage for certain types of oral surgery, dental implants, or orthodontia.
Dental insurance is included in many fringe benefits packages or comprehensive plans. It may be based on a co-payment and/or incentive plan, with the company's co-payment increasing each year until 100 percent coverage is reached. Limits are usually low, from $1,000 to $ 1,500 a year.
- Discount or referral dental plans
Actually this type of dental benefits program technically isn't dental insurance at all. The plan carrier company has contracted with dentists who have agreed to discount their dental fees in exchange for a larger load. So you only have to pay according to the predetermined (discounted) fee list.
(1) Traditional dental insurance plans / Indemnity dental insurance plans.
This type of dental insurance plan makes payment for the dental treatment on a traditional fee-for-service basis. For some dental treatments (such as preventative dental care) the payment made by the insurance company might be in full. For other types of dental services, it is commonplace that these types of plans will cover between 50 and 80 percent of the cost of treatment.
The payment that the insurance company makes will wary from plan to plan, but it is usually based on one of the following two schemes:
- Usual, Customary, and Reasonable" ("UCR") dental insurance plans.
This dental plan bases its payment calculation on either the insurance company's proprietary "UCR" fee or else the dentist's fee, whichever is less. You need to settle the remainder of your bill.
- "Table of allowances" dental insurance plans.
These dental insurance policies utilize a list that outlines the dental procedures covered by the plan. Each procedure on the list has associated with it a set dollar amount that the plan will pay when that particular service is required.
(2) Managed Care Dental Insurance Plans. Capitation Dental Plans (Dental Health Maintenance Organizations). The dentists are paid the same amount no matter how much treatment they provide for the plan members. So some dental treatments are provide at no charge to the individual, while others require a co-payment.
B) Preferred Provider Organization ("PPO") dental insurance plans.
When you choose the dentists from the network, the dentists have agreed to discount their fees.
While you receive dental treatment from a dentist who is not a member of their network, you will be penalized with a lower level of plan benefits (higher deductibles and co-payments).
C) Exclusive Provider Organization ("EPO") dental insurance plans.
Different from the PPO, you are offered no option other than receiving your dental treatment from a dentist who is a member of the dental insurance company's network of providers.
What should you look for in a dental plan? 1.Read carefully through the details of the dental insurance plan you are taking into consideration and evaluate the coverage they offer for preventative and diagnostic procedures. A dental insurance ought to make such dental care very affordable, or even better yet, cover them at 100% as follows:
- Dental examinations - twice per year.
- Bite-wing x-rays - once per year.
- Teeth cleanings - twice per year.
- Full mouth x-ray series - once every three years.
- Topical fluoride treatments - twice per year.
- Dental sealants.
2. When you find a dental problem you had better have the dental treatment required to rectify it suggested by your dentist. The dental insurance should provide enough assistance that the dental care is easily within the individual's financial reach. Many dental plans will cover 70 to 80 percent of the cost of the following types of dental work.
- Restorative dental treatment - fillings.
- Endodontic treatment - root canals.
- Oral surgery - tooth extractions.
- Periodontal treatment - gum treatment.
3. Many dental plans cover 50 percent of the cost of "major" dental services. Some of the types of dental work that are classified as "major" dental procedures are:
- Fixed prosthodontics - dental crowns, bridgework.
- Removable prosthodonitics-partial dentures, complete dentures.
Tips for purchasing dental insurance
When you choose a dental insurance , you have to think about such questions as follows:
- How much will it cost me on a monthly basis?
- Will I be asked to meet a deductible? Once the deductible is met, how much will the dental insurance provider pay for my services?
- Is there a dollar limit on the total amount of benefits that the dental insurance company will pay?
- What dentists take part in the network? Are these dentists that my family and I would be convenient to see?
- If I use a dentist outside the plan's network, how much will I have to pay?
- Are there waiting periods for certain procedures?
- Ask others enrolled in the dental plan about their experiences. Did the dollar amount of the plan's benefits live up to their expectations?
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