Employee Benefits

Employee Benefits - Dental Insurance

 
 


Insurance companies offer a variety of dental plans with different features.  The best way to take full advantage of your dental plan is to understand each feature. Most dental programs have an annual dollar maximum, deductible and some form of copayment or coinsurance. There is always a maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period. The patient is personally responsible for paying costs above the annual maximum.

Most dental plans also have a specific dollar deductible. It works like your car insurance deductible. During a benefit period, you personally will have to pay a portion of your dental bill before your insurance carrier will contribute to your bill. Your plan information will describe how your deductible works and once met, you will most likely have a copayment policy. That means the insurance carrier might pay a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance.
 
Many dental plans offer three classes or categories of covered treatment. Each class provides specific types of treatment and typically covers those treatments at a certain percentage. Each class also specifies limitations and exclusions. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully.

Here is the way the three levels typically work:

  • Class I procedures are diagnostic and preventive and typically are covered at the highest percentage (for example 80 to 100 percent of the plan's approved fee). This is to give patients a financial incentive to seek early or preventive care, because such care can prevent more extensive dental issues or even dental disease itself.

  • Class II includes basic procedures -- such as fillings, extractions and periodontal treatment -- that are sometimes reimbursed at a slightly lower percentage (for example, 70 percent to 100 percent).

  • Class III is for major services and is usually reimbursed at a lower percentage (for example, 50 percent). Class III may have a waiting period before services are covered.

Dental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical program includes limitations and exclusions, meaning the program does not cover every aspect of dental care. This can relate to the type of procedures or the number of visits. These limitations and exclusions are carefully detailed in plan booklets and warrant scrutiny.