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Dental Insurance & Plans

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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

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

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

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 

* 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 

* 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

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 

* 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 

* What are the provisions made for dentists in the event of unforeseen 

* 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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