Dental Insurance Introduction Shaving nicks and toothaches hurt more than they should. While a nick will vanish in a couple of days, toothache will take your pocket for a spin before it goes away. Believe me, dental care is prohibitively expensive, but still a part of necessary health care and very important. Here comes dental insurance. Not much in the past it was considered a big company perk, dental insurance has today established itself as a must-have benefit. Even most small companies offer dental insurance today to recruit and retain workers. Dental coverage costs less than 10% of total medical coverage so its affordable and preventive procedures, like cleanings, ensure the overall health of employees, which means a decrease in sick time and increase in productivity. Various dental insurance plans with numerous variations are available today. You should take proper care and time to consider all options. Most expensive plans: * Direct reimbursement plans These plans are the most expensive of the lot. They operate by paying for employee dental coverage from a pool of money set aside by the company for this purpose. The simplicity of this plan makes it the most effective, the reimbursement is made by a simple formula doing away with the complexity of co-payments, deductibles etc. Even though ADA strongly recommends this plan, this kind of direct dental care may not be affordable by smaller companies. Least expensive plans: * Managed care plans Similar to a medical HMO, managed care dental plans need to pay for the treatment through regular co-payments and choose forma pool of dentists to get treated. These plans do various cost-control measures and can more affordable for small businesses. The co-payment amount varies according to procedure. Preventive procedures are usually performed without co-payment, however advanced procedures will bear higher co-payments. The choice lies with the company and their financial managers, however great care is recommended in choosing the plan. Dental Insurance Does one need Dental Insurance? This question is asked by us in parlance with any kind of insurance. Well, insurance is a tool that offsets financial losses due to accidents or incidents or unforeseen circumstances. With this in view, insurance is always advocated but if one is young and healthy and doesn't need to visit a dentist more than twice a year, dental insurance will not be a requirement, since the premium for such insurance may be more than the annual tooth maintenance bill. People with a turbulent dental history are advised to purchase dental insurance or join a discounted dental plan for the simple reason that dental bills can turn out to be very steep. Millions of Americans are undergoing root canal and cavity procedures despite the fluoride in drinking water. Dental health in the USA has not been of very high standard over the decades. Dental health depends upon a variety of factors including dental hygiene, stress, personal eating habits, nutrition etc. The programs of dental coverage available are Indemnity Plans, Preferred Provider Plans, HMO Plans and Discount Plans Dental Indemnity Insurance Plans These are normal, traditional insurance coverage plans where you get a percentage of your dental bills covered for a monthly fee or premium. Normally a indemnity plan covers 100% of preventive services, 80% of restoration services and 50% of major treatment like orthodontics. Dental Preferred Provider Plans These plans cost an average of $40 per month and give you highly discounted rates of dental procedures within the specified network. A few benefits are available outside the network also. These plans are regulated by state insurance departments and fall in the insurance category. HMO Dental Insurance These insurance plans are also known as capitation plans. They operate like Health Maintenance Organizations (HMO). These are also regulated by state insurance department and cost between $20-$40 a month. Dental Discount Plans Discount dental plans are like clubs where you get the best deals when you show your membership card. These are again network based. They give best value to individual and family memberships. This membership is only purchasing a discounted access to a network dentist and is not considered insurance. Popularity of Dental Insurance The benefits of dental insurance coverage have been further stressed upon by the popular icons on the television, who always seem to have flashing white flawless teeth. These teeth are a result of care, expensive dental care and thus need for expensive group dental insurance plans provided by insurance companies that reducing in number by the day. Group dental insurance plans have been growing rapidly placed in the niche market of employee benefit programs. A few years back, dental insurance was a non-descript part of employee benefit programs and very simple to plan and execute. Most plans used were for full coverage of preventive care and cleaning, 80% coverage for basic restoration and 50% coverage for major restorative services like crowns and bridges. Despite advice many employees never visited their dentists resulting in the overall cost of insurance being low and stable compared to general health benefit plans which rose year after year. For many years dental insurance was a simple rider for employers who took it major plans from big insurance companies. The last few years saw a spurt in television advertising and as the smiles brightened on the idiot box, the importance of whiter smiles and straighter teeth became apparent and people started taking more interest in dental care. This in turn saw a spurt in rise of dental insurance premiums almost at the rate of 7-10% a year. This rate is significant and big employers started looking at it with a bigger eye. This tells on the bottom-line of the company since the employee benefit expenses are going up due to this rise. The dental insurance costs about 10% of the total employee benefits for a corporate today. So the rise in premium year after year, pushes the total employee benefit expenses 1% higher year after year. "Employers aren't paying that much attention yet, but considering the way dental plans are evolving, they should," says Donald S. Mayes, dental plan auditor and consultant from Hershey, Pennsylvania. Dental Insurance plans, as a part of employment package have also increased in popularity. So big companies, to recruit and retain their employees cannot do away with these plans; at the same time have to watch the cost going upward. A Catch 22 decision is awaited. Dental Insurance vs. Discounted Dental Plans Oral health and maintenance of the same is a very important part of a healthy lifestyle. Prevention and correction of dental problems on time is essential to stem the damage to one of the most important organs of the human body. Many people do not realize the importance of maintaining their oral health. Most Americans who do are without effective dental coverage. This is mainly due to cutting costs by major businesses effecting employee dental benefits. People who are used to regular maintenance of dental health are looking at options where they can get dental benefits. One main question on their minds today is "How benefits differ between Dental Insurance and Discount Dental Plans?" Dental insurance is not available for individuals and families. Is traditionally a coverage offered by employers to their employees who pay monthly premiums for fixed coverage. This kind of coverage has drawbacks -- ceiling on spending, deductible or non-reimbursable issues, and waiting periods for certain kind of dental procedures, limitations and care or disease exclusions. This kind of coverage also involves submission of claims. Dental Insurance traditionally covers preventive dental services like cleaning and routine examinations at 100% after deductibles are adjusted (they may vary from $20-$50 annually per individual). However, the choice of the dentist is up to the individual and premium is about $30 a month for individuals and $100 a month for families. Discount dental plans on the other hand offer dental benefits to everyone and are designed to give access to the dentist networks at discounted rates. They are also known as reduced fee dental plans or affordable dental plans. They are easy to join and does not involve any paperwork. Discount dental plans are generally membership programs that provide coverage on an annual basis with monthly membership fee. Consumers get secured discounts on dental services like exams, routine cleanings, extractions, root canals, fillings, dentures, and braces. They save the consumer 10-60% percent off standard fee of visiting a participating network provider or dentist. The traditional dental insurance and discounted dental plans can also be clubbed together in certain situations to maximize savings. Dental plans and Dental insurance Dental coverage is normally not underwritten by insurance companies because the treatment and medication of dental needs are predictable and follow a time table. No individual would opt for a dental insurance plan if he were to pay more in premium than in annual dental charges, and the insurance company would lose money if they pay more in claims than the premium collected for each policy they underwrite. Despite these drawbacks, some companies offer dental benefits by group discount schemes. These are also called discounted dental plans or affordable dental plans. These are a kind of "clubs" where membership costs a little money monthly or annually where the members can avail of dental services at a discounted rate. The dental service providers or dentists affiliated to these "clubs" have agreed to provide dental services at a discounted rate. The payment is made directly by the patient to the dentist, no paperwork or claims or future hassles. These "clubs" only do matchmaking between the patient and the dentist, earning money in the process. The dentist in turns gains to earn due to larger volumes of work. The patient gets the service at a discounted rate. It's a WIN-WIN for all parties involved. Dental Insurance when offered is again a complicated issue. The insurance company generally stresses upon background checks and pre-existing conditions. After this goes through you have to wait out until the coverage starts. When the treatment is actually undergone, a lot of paperwork regarding claims, %age exclusions etc. come to the fore where it becomes more of a pain to actually undergo and finish the process of reimbursement. However insurance has its own benefits and plans have their own. A lot of employers also provide dental insurance whereupon the need for plans ceases for the individual. It's for the individual to decide between the two as per their requirement, needs and current situation. What are discount Dental Plans? In general Dental plans are a low cost alternative to dental insurance. Dental care services become more affordable with discount dental plans for families in the lower income bracket. A dental plan is a kind of a club you join where we have a section of providers and consumers. In a discounted dental plan, the providers have agreed to provide the services at a discounted rate. As a consumer, one just has to display his or her membership card while visiting the provider. These discounted dental plans do not purport to insurance in any way, they are just discount programs. Choosing a Dental Plan While taking a decision on a discounted dental plan, it is important to be fully informed so that one can make a confident decision. The internet would be great tool to search for various plans in your area and compare them. Keeping the cost and benefits offered in mind, an informed decision can be made against the backdrop of your needs. Joining or enrolling in any of these plans is easy and quick; you just have to pay the fee using your credit card or electronic check and get the package online, in a matter of minutes. Many of these packages come with a 30 day money back guarantee, which means if you are not satisfied with the package or services, you can get your money back within 30 days without any questions being asked. Many discounted dental plans offer ways to save on more than dental care, offering discounts on pharmacy prescriptions, vision etc. Keep these in mind while comparing the plans.
Using your discounted Dental plan After you join a discounted dental plan you can start using the plan immediately without any waiting period. Benefits for most discounted dental plans are activated within 48 hours from enrolling. When you use the discounted dental plan, make sure you call the empanelled provider dentist for an appointment. When you reach the dentist to keep your appointment, make sure you show the discount dental plan card to the receptionist to avoid confusion, it will ensure that you are charged the discounted rate in the first place. The payment at the discounted rate is to be made at the time of taking the service. There are no hassles of paperwork and claims as in insurance plans. Advantages of Offering a Dental Benefits Plan to Employees A Dental insurance or dental benefit plan is viewed upon as a much sought after employee benefit. So financially it makes sense to have a dental benefit plan in place to recruit and retain employees. Moreover, dental health is a very important part of overall employee health and man days lost due to dental problems or dental discomfort of an employee equates to financial loss for the employer. Unlike most medical conditions, dental maladies and treatments are low risk, predictable and low cost. These factors contribute to offering dental insurance to employees a good option financially. Dental diseases are preventable by maintenance and often involve only maintenance costs like x-rays and examinations. Treatment is rendered cheap due to diagnosis in early stages of the disease. Keeping these financial factors in mind, dental insurance options can also be self funded. History does not show any extremes in costs or utilization of this form of employee benefit. Selecting the right Dental Insurance Plan Selecting the right dental plan involves a lot of factors which have to be considered with due care. Dental insurance plans are basically agreements between the employer and the insurance company. Most plans offered by dental insurance companies allow for part reimbursement of dental treatment expenses. Many plans also discourage certain kind of treatments or allow access to certain of dentists. To consider these points one has to go through the plan very carefully with a toothcomb. For example choosing a dentist is not same as choosing a dentist from "the list", or if the plan does not cover one kind of treatment, it is wrong to infer that your regular dentist is incompetent. Many plans do not cover pre existing conditions. Some may not cover implants and so on. Due to these preconditions, the final treatment may be paid for in part only or in insurance parlance you might be reimbursed for LEAT (Lease Expensive Alternative Treatment). Dental insurance plans vary in fixing the UCR (usual, customary, and reasonable) in a certain geographical area. UCR may vary from plan to plan and company to company despite operating in the same area. Therefore fixation of this UCR level would define the liability of the patient. In some plans the patient may have to pay more and in some he may have to pay less depends upon the plan the employer has offered. Important factors while finalizing on a Dental Insurance Plan An employee has to ask himself the following before he finalizes on a plan: * Would the employees like to retain the freedom of choosing their own dentists? * Will the mode of treatment be determined by the patient and the dentist? * What type of routine and preventive dental care is covered? * Does the plan cover braces, oral surgery, crowns and bridges, root canals and treatment of periodontal diseases? * Will the plan cover all diagnostic, preventive and emergency services? Including preventive services viz. sealants & fluoride treatments, which might result in financial savings to the patient in future? * Does it provide for full-mouth x-rays? * What forms of major dental care is covered? * Does the plan cover implants, dentures, or treatment for temporomandibular disorders? * Does the plan allow for specialist referrals? If so, has the dentist be limited to "the" list of specialists to choose form? * Does the plan provide for emergencies? * What are the provisions made for emergency care when the patient is on tour? * What percentage of monthly premiums goes into actual care and not to administration? Dental Insurance benefit coverage should be taken into consideration but should not be the deciding factor in choosing the treatment. Dental Insurance Plan Models There are numerous dental plans available. Basically they are of two kinds: Managed care and Fee-for-service. Managed care dental plans are restricted forms of dental insurance which aim at reducing costs and payouts. They tend to restrict the coverage by limiting the access to care by restrictions (by predefining dentist, specialist, hospital or treatments in form of lists) and restricting level, type and frequency of treatment (usually in form of clauses in the coverage policy). Fee-for-service dental plans have a freedom of choice options where one can choose their own dentist and the fee is paid as fixed by the dentist. Kinds of Dental Insurance Plans Managed Care Dental Plans Preferred Provider Organization (PPO) plans are plans in which the patient has to select a dentist from a list provided to him. These dentists have agreed to discount their fee by contract with the insurance company. Some PPO plans also allow patients treated by dentists outside their list, where the patient is penalized by excess co-payments and higher deductibles. PPO's are normally less expensive than indemnity plans in their class. Keep the following in mind while reviewing a PPO Dental Insurance Plan: * What is the percentage of the premium used for administration? * Will the discount influence patients to change their regular dentist? * Will the amount of the discount the dentist ahs to offer affect the number of treatment options for the patient? * What is the liability of the employer in the event of the plan influencing dentist selection or treatment? * What are the criteria of selection of dentists for the plan? Does it have adequate number of dentists under contract? * What is the geographic distribution of dentists? * Does the PPO dental insurance plan provide for specialist referrals? If so, are the dentists limited to a specialist on the "list" only? * How does the plan provide for emergency treatment? If so then how does the plan provide for emergencies outside the geographical area? Dental Health Maintenance Organization (DHMO) or Capitation plans are designed in such a way that the patient does not have any financial payout when he goes for treatment. These plans pay the dentists on their "list" a fixed amount of money monthly per enrolled family or individual, regardless of visits. In return, the dentists provides specific types of treatment to the patients who visit him at no charge, any other types of treatments require co-payment. This way, the DHMO is rewarding dentists to keep patients in good health, thereby keeping the costs low. This kind of plan is one of the least expensive. Factors to consider while reviewing a DHMO plan: * What is the percentage of the premium used for administration? * Does the employer have access to enough information for him to determine the level and amount of treatment rendered to each of the employees? * What is the utilization percentage for patients in this plan? Average waiting period for an initial appointment and average period between appointments has to be given due consideration. * What is the dentist/patient ratio for the DHMO plan? * What is the criterion of dentist selection in the program? * What is the geographic distribution of dentists? * What percentage of dentists is selected for from those who applied to participate? * How many dentists withdrew from the program in the recent past? * What is the rate of compensation for the dentists? * Is it sufficient compensation for the needs of the covered patient population? * What are the provisions made for dentists in the event of unforeseen utilization? * What are the benefits for patients needing a specialist's care? * How are specialists selected and compensated? * Does the plan have adequate specialists? * Does the program provide for any emergency treatment? If so, is it available outside the geographical area? Fee-for-Service Dental Plans Direct Reimbursement (DR) plan is a self-funded dental insurance benefit plan which reimburses patients on actual spent on dental care. It is not based on the type of treatment received. The patient has complete freedom in choosing the dentist. The employers are liable to pay a percentage of actual treatment cost, but they do not have to pay monthly premiums for employees who do not need the benefit. Moreover the employer is free of any responsibility to take decisions on mode of treatment due to previous plan selection or sponsorships. Direct Reimbursement Dental Insurance Plan is American Dental Association's preferred method of dental coverage.
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