Posted November 3, 2011
Educational information to share with employees
Annual employee benefit surveys confirm that employees highly value their benefit plans, with dental insurance ranking among those they value the most. Scheduling an appointment for a checkup and cleaning is an important step for employees and dependents to maintain good overall health. During the exam, the dentist not only will evaluate the patient’s oral health, but also will look for signs of potential medical concerns.
Sometimes employees hesitate to use their dental benefits because they don’t understand the terminology associated with their plan benefits. Here’s an overview of terms frequently used in dental plans:
- Preventive – Provides benefits for routine checkups and services, such as exams and cleanings, designed to prevent tooth decay and detect possible signs of oral diseases
- Basic – Includes coverage for common restorative procedures, such as repairing damaged teeth with fillings or performing simple extractions; can include nonsurgical treatment of oral diseases, such as endodontics (root canals) and periodontics (gum disease)
- Major – Features restorative procedures to repair severely decayed or fractured teeth with crowns, dentures or bridges; can include space maintainers, crown repair, surgical endodontics and periodontics, complex extractions and anesthesia
Usual & Customary (U & C)
Insurance companies typically identify a set amount that they will pay dentists for each procedure. For example, your dentist may charge $100 for a cleaning and checkup, but the insurance company may pay only $85 based on the use and customary charges for dental procedures in that area. If the service is provided by a participating network provider, you may not have to pay the difference. But if you use a nonparticipating dentist (out-of-network), ask for pricing information in advance.
Dental plans usually cover the cost of preventive care services, but feature a waiting period of several months to a year before providing benefits toward the cost of major procedures. Check the plan for any restrictions before scheduling an appointment for treatment options requiring extensive care.
Each plan features a maximum benefit amount the insurance company will pay toward yearly dental services covered by the plan. Most plans have an annual maximum benefit, anywhere from $50 to $2,000. (A few carriers – like us – offer a plan option that rewards qualifying employees with a carryover amount that increases their next year’s annual maximum.)
Deductible or Copay
Most dental plans also feature an amount (called a deductible or copay) that employees must pay before the insurance company will cover the procedure.
Do you have questions concerning dental insurance terminology? Is it difficult to understand your dental insurance terminology? If so, please visit us at ameritasgroup.com, select Member, go to the Resource Center and click on Glossary. We’re here to help! – Karen Gustin, Ameritas Group