Dental insurance policies cover routine and major dental work, but may not offer 100% coverage for major procedures. Employers may offer dental insurance riders, but coverage may be limited. PPO plans are preferred by dentists, while HMO plans limit reimbursement. Individual plans can cost up to $80 per year, but may not cover major procedures. Some employers offer informal reimbursement for routine visits, and emergency procedures may be covered under standard health plans.
Dental insurance is offered by insurance brokers to cover routine and in some cases not so routine dental work. Dental services covered by a typical dental insurance policy may include cleanings, fillings and crowns, emergency tooth replacements, non-cosmetic oral surgeries, and x-rays. However, the term “dental insurance” can be a bit of a misnomer. In today’s world of managed health plans, dental insurance agencies tend to call their plans PPOs (Preferred Provider Organizations) or HMOs (Health Management Organizations). Dental insurance plans are less likely to offer 100% coverage for major dental procedures.
Group health insurance plans provided by employers may or may not include a dental insurance rider. Employees may need to seek additional coverage or seek out independent dental insurance agencies. If dental insurance is provided, your employer may place restrictions on the types of dental services covered by the plan. Employees are provided with a list of dentists participating in the group dental insurance plan. This is considered a “preferred provider” arrangement, hence the common abbreviation PPO. A PPO dental insurance plan is preferred by dentists because the insurer pays at least 80% on most claims. Routine dental visits can receive 100% reimbursement, while major oral surgeries and cosmetic procedures can reimburse the dentist 50%.
A less satisfactory option in dental insurance is the HMO plan. Under an HMO policy, insurers can severely limit the amount reimbursed to the dentist, but treatment cannot be denied to any eligible patient. Because dentists often have higher overhead costs than general practitioners, any expenses reimbursed by an HMO insurer are lost in salaries, office rent, materials, and other fixed costs. As a result, fewer and fewer dental professionals are choosing to participate in HMO dental insurance plans.
Dental insurance plans for individuals and families can cost up to $80 dollars a year in premiums. Deductibles for dental insurance plans are usually negligible or non-existent. In essence, though, many of these low-cost dental insurance plans function more like coupon books for future dental work. Even standard dental insurance coverage under a major medical plan can run up to a measly $1000 a year. A major dental procedure, such as a $3500 root canal, can easily exceed the coverage provided by traditional dental insurance.
Some employers provide a more informal arrangement for employee dental care. A certain percentage of the dental bill for routine visits can be reimbursed out of pocket by the company instead of filing a claim. Some emergency dental procedures may also be covered by standard health plans, as long as they qualify as a medical need. A child who loses a tooth in a bicycle accident, for example, may be covered if the ER doctor calls an oral surgeon to replace it. Otherwise, any non-urgent visits to a dentist would have to be paid for out of pocket or through specific dental insurance claims.
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