Employee Benefits

Understanding Dental and Vision Coverage in a Medical Plan

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Two-for-one promotions sound like good deals, but often one item is good and the second does not quite match up to expectations. It is the same with medical insurance that includes coverage for dental and vision care.

Review these five tips to better understand dental and vision coverage in a medical plan.

Reputation

Make sure the insurance carrier has an excellent reputation for the quality of its plans and service. A carrier that specializes in dental and vision insurance knows how to process claims quickly and correctly.

In comparison, medical carriers are experts at processing medical claims but may not have the systems to review and pay dental and vision claims promptly. Check the carrier’s history for premium increases. Also, explore how other people rate the customer service and quality of the coverage.

Coverage

Every insurance carrier has different policies on how soon members can access benefits. Find out if the plan requires payment of an out-of-pocket deductible before covering medical, dental or vision services? If so, know the amount, when it applies and whether there is a benefit maximum.

If there is a waiting period on dental, ask whether preventive services, such as professional cleanings and checkups, are covered during this time. Know how soon you can use the plan for basic or major dental work, such as fillings, root canals or crowns. Ask for details on the percentage insurance pays toward preventive, basic and major dental procedures.

Limitations

Know whether the insurance plan has frequency limitations when dental X-rays can be taken and the number of years required for crown replacements. Some carriers have a five-year rule on crowns, while others have a 10-year limit. For vision, find out how often an eye exam is covered and how the plan pays for eyewear.

Providers

A combined coverage plan may require you to receive services from a specific list of providers. This may mean you need to change your medical, dental or vision care doctor if they are not on the list.

When reviewing benefits information, the terms “in-network” and “out-of-network” are commonly used. While they may sound confusing, it is important to understand these insurance terms and definitions. Knowing what they mean will help you avoid paying high out-of-pocket costs.

Stand-alone plans

Although a combined plan may look like a good benefit option, do not feel pressured to make this choice. It is completely fine for employers to offer their employees stand-alone dental and vision insurance separate from medical. It is also perfectly ok for employees to purchase individual dental and vision insurance on their own, separate from medical or Medicare coverage.

Stand-alone benefits usually are a better choice for employees. These plans typically offer:

  1. Coverage for the entire family (adults and children) with the option to add
  2. Extensive dental and vision provider networks across the country.
  3. Options to better tailor benefits to fit the needs of employers and employees.
  4. Accurate premiums so employers and employees can avoid unexpected rate increases each year at renewal time.
  5. Superior customer service and claims processing specifically designed for dental and vision services.

Dental and vision are popular benefits and easier to understand than medical coverage. However, a recent Ameritas survey discovered that some employers and employees do not always understand their dental or vision coverage. For example, they may find the terms used in insurance plans confusing. Ameritas strives to be easy to do business with and also specializes in dental and vision. Read this blog that explains the survey results.

Employers may offer employees stand-alone dental and vision plans on a contributory or voluntary basis. Or employees and retirees may purchase individual dental and vision benefits online for themselves.