Dental insurance, what the insurance companies didn't tell you.
What is dental insurance?
Dental insurance covers the patient against dental costs. It is
not uncommon to have a dental insurance or dental plan together
with your health insurance. Some employer will offer some form
of dental insurance over and above the company medical insurance.
Unlike health insurance that covers diagnosing, treating and
curing serious illnesses, dental insurance mostly covers
preventive treatment. Dental treatment is highly predictable and
very often non-catastrophic. Most dentists will advise patients
to have at least one check-up every six months, that kind of
preventive treatment is covered by most good dental insurances.
Dental plans very often encourage patients to have regular
dental check and promote good dental hygiene, it is in there
best interest to offer such plans with the dental insurance.
Do i need dental insurance?
As mentioned, unlike health insurance, dental insurance is very
predictable and as such is not always a good candidate for
insurance.
For example, most dental insurance will offer $1000.00 cover per
year, but the fact is that most patients never require more than
$100.00 per year. Self funding might be a better option as it
removes the dental insurance overheads.
The employer option
But if something goes wrong then you might need a comprehensive
dental insurance cover or access to funds that you might not
have.
This is why some employers offer Direct Reimbursement (D.R.),
the employer takes a percentage of salary into a dental
insurance fund and this covers the employees.
The insurance companies response
To offer cheaper dental insurances than the one offered by
employers, insurance companies responded with HMO's and
Preferred Provider Plans (PPO's). Under those plans the
insurance can offer cheaper premiums, but the treatments offered
are often very limited. Another problem is that the dentists
often increase the waiting lists and limit specialist
treatments.
The common options
Although the employer dental insurance is often the better
option you need to look at that they actually offer you.
Who will select the dentist?
--Open Panel, you choose the dentist without any restrictions.
--Close Panel, you are given a list of dentist to select, they
in turn signed an agreement controlling their charges with the
dental insurance company.
--Preferred Provider Organization (PPO), Group of dentist that
offer to charge less, if you want someone else, you might need
to pay the difference.
--Exclusive Provider Organization (EPO), Group of dentist that
offer to charge a lot less, but then the client cannot go
anywhere else, (unless they pay the full price).
As you can see the more you go down the list the more
restrictive the options are, typically an Self-Funded Insurers
will offer an open panel whereas Dental Service Corporations and
Insurance Carriers will offer EPO's.
How is the dentist compensated?
--Payment plan, the patient pays a monthly fee to the insurer
and in turn the insurer pays the dentists/specialist.
--Capitation Plans, the dentists charges the insurance company a
certain amount per-capita, (per patient), and in turn offer to
treat the patient.
--Direct Reimbursement Plans, the patient pays the full price
and the dental insurance plan will reimburse all or some of the
money.
The second option is very limiting as some rogue dentists are
inclined to offer substandard treatment to maximise their
profit. The last option allows you to choose the best treatment
plan.
All above can limit the percent value that is actually been
repayed and/or cap the yearly value that can be (re-)claimed.
How are the benefits and payments calculated?
--A list is given of what is covered and for how much, any
amounts over are not reimbursed by the dental insurance.
--The dental insurance offers a maximum amount that can be
reimbursed per year, as long as the patient is within that
figure the insurance will cover them. This is great for long
term treatments, allowing the patient to choose the best value
for money and overall treatment for their need.
What ever cover is offered by the dental insurance you must make
sure that it has a regular review to ensure that the benefits
are fair and reasonable.
Find out more about dental
insurance