Dental Insurance Plans | Things to consider

Monday, January 15, 2007

Many people find themselves overwhelmed when it is time to choose a dental insurance plan that is right for them and their family. Some employers do offer dental plans in which the employees have little input to what is offered in the plan. For those of you who do not have dental insurance coverage provided by an employer, the following are a few things to consider when choosing a dental insurance plan;

Who is the coverage provided for?
With many dental plans, it is customary that the policyholder, spouse, and any dependent children from birth to 18 years of age are covered. However, you want to make sure that this is the case with the dental insurance policy you are reviewing. Should one or more of your depedents be over the age of 18, you need to look into what the stipulations for coverage are as well as any additional expense. You will also want to review exactly what is covered for your spouse and any dependents and the amounts.

Are you allowed to choose your own dentist?
Many dentists choose to participate with a variety of different dental insurance providers. What this means is, your dentist and the dental insurance provider have worked out an agreement for reduced fees for dental treatment. The dentist is most often paid directly by the insurance company. You would then be billed for any amount your insurance company did not pay.

Should your dentist be a non-participating dentist, it still means that you will be able to continue to receive treatment from your dentist and submit claims to the insurance company, but the insurance company will base their payment on what they determine is a "Usual, Customary, and Reasonable", (UCR) fee.

For example, your dentist charges you $60.00 for a composite filling, (white filling), on the occlusal, (biting surface) of your first molar. The claim is then submitted to the insurance company. The insurance company receives the claim and reviews it. Taking in a number of factors such as, participating or non-participating dentist, and area where you live, the insurance company may have determined their UCR fee is $55.00. You or the dentist would then be issued payment based on $55.00 instead of the submitted $60.00 charged by the dentist. If your dental insurance policy states that 50% will be covered for one surface dental fillings, you or your dentist would be issued a payment of $27.50, provided the deductible has been met, if any, and the maximum benefits have not been reached.

Exactly which procedures are covered?
A good dental insurance plan will allow for a dental cleaning and check-up every 6 months. Sometimes, fluoride treatment and x-rays are included. For procedures such as crowns and fillings, many plans will offer coverage of 50% of the fee charged. You will need to look into exactly what procedures and amounts are covered for your dependents as well. Other things to consider for treatment are orthodontics, endodontics, (root canal procedures), periodontal, (gingival "gum" tissue), and oral surgery. Depending on the needs of you and/or your dependents, you may be able to ask for less coverage in some areas such as fillings and crowns, or increase coverage in areas such as othodontics.

Are there any restrictions?
Some dental insurance plans place caps on the number of treatments one can receive in a year. Are you limited in the number of crowns or fillings that can be submitted for coverage per year? Are the restrictions, if any, for everyone on the policy? Are the restrictions added together for each person on the policy or is each individual allowed only so many fillings or crowns per year? How many dental check-ups, fluoride treatments, and x-rays are allowed per person per year?


Make sure to take your time and compare dental insurance plans and the companies offering them. Just because the insurance company might offer plans with rates that fit into your budget, does not necessarily mean that those plans offered are right for you. Write down what is important to you for coverage and then compare dental insurance plans online, in a notebook, or create a spreadsheet. Do not base your descision on monthly, quarterly, or yearly rates alone. You also want to research the companies who are offering the plans you are most interested in. Do the companies have a good reputation? Do they provide good customer service and support? Do they pay on time?