Index | Dental Insurance | Dental Insurance
For most of us, dental procedures are a necessary evil. Very few lucky people have never experienced those unpleasant feelings at the dentist's waiting room and a slight shock at seeing the bill afterwards. However, even those few lucky ones face the necessity of visiting the dentist some time or other. Dental hygiene is far from being the only factor that influences the health of our teeth. Nutrition, genetic inheritance, general state of health, personal habits and stress, - all these things have a great effect on our dental health. In the society where a smile is a mandatory "dress code," the need for purchasing Dental Insurance or joining a Dental Discount Plan does not raise doubts.
It is likely that you get your dental coverage at work. If your employer offers dental coverage, try and find out if you have several types of dental plans to choose from. Most dental plans cover a maximum of $1000-$2000 of dental services per year, and you will have to pay for the rest of the dental expenses. If your employer does not offer dental coverage, you are advised 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-ray pictures, cleanings, and some other procedures preventing tooth and gum disease. Since regular dental care prevents more serious potential problems, such coverage can be rather important.
Basic Dental Care and Dental Procedures
Basic dental procedures include fillings, fixing chipped teeth, tooth extractions, periodontal treatment, root canals, etc. However, with some Dental Insurance providers, some procedures can not be listed as basics, for instance, root canals. It is up to you to select a Dental Insurance provider who covers most items of basic dental care and dental procedures.
Major Dental Care
Major dental care usually includes dental surgery, denture work, orthodontics, and other serous expensive dental procedures. Some Dental Insurance plans cover a portion of major dental care costs.
Types of Dental Plans
Dental plans are contracts between the sponsor (an employer or organization) and the third party (an insurance company), according to which you can arrange your dental treatment into the most suitable pattern. Usually Dental Insurance plans do not cover the full cost of dental care. Dental care programs have some provisions that limit the amount the insurance company will pay. Common methods of payment limitation are deductibles, co-payments, and dollar limit programs. All limitations in dental coverage are stated in your dental coverage policy and appear to be the result of an agreement between the sponsor and the third-party. An average dental plan covers 100% for preventive measures, 80% for basic dental work, and 50% for major procedures.
There are various types of Dental Insurance plans ranging from covering only 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 dental plan types.
If you choose Indemnity Insurance Plans, you agree to pay your insurance company an established monthly fee (around $14 to $26 per month), while your insurance company agrees to pay your dentist for dental services carried out. The policyholder is usually liable for 20-50% of the total service costs.
Dental Health Maintenance Organization (DHMO) is a pre-paid dental care plan, in which a fixed monthly fee goes to a participating dentist by DHMO for each patient assigned to the given dentist. The Dental Insurance policyholder may have to contribute to the cost of his/her treatment. These insurance plans normally deal with preventative and emergency care, thus varying from patient to patient.
According to Preferred Provider Organizations insurance plan (PPO), you can choose to visit dentists from a preferred supplier list at a large discount. With this insurance plan, you might pay about $25 per month. If for some reason you wish to apply to the dentist who is not covered by this dental plan, you can still get some discount, but not as much as when you stick to the dentists on the list.
Point of Service Plan (POS) is a Managed Care plan according to which a patient can receive treatment from a non-participating dentist at lower benefit levels.
Direct Reimbursement (DR): Using this type of dental plan, you choose your own dentist and treatment plan. After you have paid for dental treatment you received, you can submit the receipt to your employer for reimbursement. This is a straightforward plan that allows employees to avoid the complexity of lists, deductibles and paper work. However, this dental plan is often too costly for many small businesses.
Understanding Dental Insurance is important for both your health and your budget. You should be perfectly aware of what is covered in your policy and what is excluded, how much you will have to pay, what waiting periods there will be before your coverage starts working, etc. Most dental programs do not cover dental treatment solely for cosmetic improvements. Hospitalization is not usually covered either.
You can consult with your dentist not only about your dental care, but also about Dental Insurance claims. He/she can provide you with the necessary information and you will be able to prepare the claim yourself, or your dentist will help you by filing insurance claims for you. Dental coverage is there to help you reduce your dental expenses, but only your health and expert advice should be determinant in your dental treatment decisions.