Dental Insurance

Dental insurance plans are not very common, as the medical needs for dental care can be quite unpredictable. Also, with premiums sometimes being higher than the dental coverage itself, the likelihood of opting for such a policy would be negligible. It would also serve unprofitable to the insurance company as they would lose money by spending more on benefits then receiving in premiums on every plan they write. However, some of the insurance plans that are offered by companies are called referral plans or buyer’s club. Here, an individual pays a monthly fee to a third party in return for access to a list of dentists who have agreed to a reduced fee schedule. Payment for treatment is made from the patient directly to the dentist. The role of the third party is to get the individual to the dentist. The dentist receives no payment from the third party; only referrals of patients.

While some dental plans exclude treatment that is covered under the company’s medical plan, others discourage necessary dental treatment such as sealant, pre-existing conditions, adult orthodontics etc. Some exclude treatment by family members. Patients must be aware of all the exclusions before going in for a dental insurance policy.

While choosing a dental insurance plan, ensure that your policy covers the care of your family as well. You should discuss your family’s current and future dental needs with your dentist before deciding on your dental plan. The benefits of your dental plan coverage will be provided by the plan purchaser, often your employer or union, and by the third-party payers. Your dentist may not be able to answer specific questions about your dental benefit or predict what your level of coverage for a particular procedure will be. This is because insurance plans written by the same third-party payer or offered by the same employer may vary according to the contracts involved. Therefore, you should ask the plan purchaser or the third-party payer to answer your specific questions about coverage. Ensure that you and your dentist are aware of all the benefits and exclusions in advance of treatment.

Typically, if you and your spouse both have a dental benefit plan, you may get additional coverage from each other’s programs besides your own individual benefit. However, the benefit derived from the two programs cannot exceed 100% of the dentist’s charges for treatment. This if you have two or more potential sources of coverage, check the coordination of benefits for each plan to determine what is available.

It is important to know how your plan is designed, since this can significantly affect the plan’s coverage and your personal expense. There are many ways to design a dental benefits plan. Although the individual features vary with every plan, the most common plans are as follows:

Direct Reimbursement Programs
Usual, Customary and Reasonable Programs (UCR)
Table or Schedule of Allowance Programs
Preferred Provider Organization (PPO)
Capitation Programs

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