Insurance Checklist for Dental Benefits
When seeking dental insurance benefits for yourself or your employees, making a checklist of areas to review will help in your selection. Other than the monthly cost of the insurance plan, or premium, you want to consider and compare other areas such as plan type, services covered and out-of-pocket costs. Each of these can range greatly from plan to plan and insurer to insurer.
Other People Are Reading
-
Dental Plan Type
-
Most dental plans fall under two types of plans, Preferred Provider Organizations or Dental Health Maintenance Organizations. It is important to understand the different between these two types of plans. PPO plans allow greater flexibility in choosing which dentists you want to visit, but will likely have higher premiums and out-of-pocket costs than a DHMO. DHMOs limit you to seeing a dentist in a particular provider network and require that all dental care is coordinated through your primary dentist.
Services Covered
-
All dental plans will cover diagnostic and preventive services, such as exams, cleanings and x-rays. They will also cover basic restorative services such as fillings, sealants and simple extractions. Beyond these services, benefits for plans may vary. Check if the plans cover services such as endodontics (root canals), periodontics (gum treatment), oral surgery, prostodontics (bridges, implants and dentures) and major services such as crowns and inlays. Plans may offer these services for an additional premium. Also, review all benefit limitations, waiting periods and exclusions for each dental plan.
-
Orthodontics
-
Orthodontics treatment fixes crowded and crooked teeth and overbites and underbites. Many dental insurance plans exclude orthodontic treatment or add it as a high-cost rider. Check if the plan offers orthodontics for all ages or just children under a certain age. Obtain quotes for offering orthodontics to children versus all ages. Additionally, check the lifetime maximum dollar amount allowed for orthodontic treatment. Often this amount is less than the cost of treatment. Ask if the insurer looks back to treatment already received or starts the deductible over when you join the plan.
Out-of-Pocket Costs
-
Out-of-pocket costs for dental insurance, beside premium, include co-pays, co-insurance and deductibles. Include a review of these costs on your dental insurance checklists as costs can vary greatly. Review the co-pays, more applicable to DHMO plans, which are the fees paid by the patient at the time of the service. Co-insurance is the percentage of the bill the patient is responsible for paying and deductibles are the dollar amount the patient must pay before the insurer starts to pay for care.
-
