Posted January 19, 2022
Even though most people brush and floss their teeth daily, they still need dental insurance to help protect their smiles. Dental plans cover annual preventive exams and professional teeth cleanings. These dental appointments are vital because plaque buildup on teeth simply cannot be brushed away. When plaque is not completely removed every day, it has the chance to calcify and turn into tartar (also known as calculus) that’s as hard as cement.
During the exam, the dentist also will check teeth and oral tissues, looking for signs of dental problems that can affect overall health. If the dentist identifies the need for a filling, crown, root canal or other procedure, employees will be thankful they have dental insurance to help offset any unexpected costs.
As an employer, if you offer dental insurance as an employee benefit, educate workers on using their benefits throughout the year. If you don’t offer dental coverage or have employees who don’t qualify for benefits, help them purchase an individual dental plan online.
Since every dental insurance plan covers procedures differently, employers should help employees understand all of the coverage options. Review eight tips to help employees in choosing a dental plan.
Most dental plans have different benefit levels for covered procedures. For instance, Preventive/Type 1 usually is covered at 100%, Basic/Type 2 at 80% and Major/Type 3 at 50% (traditional plan). Ultimately, dental costs are determined by the member’s oral health needs. Knowing this helps identify the type of dental insurance plan needed. For example, people with healthy mouths may need only a basic plan covering preventive services and one or two fillings each year.
Many dental plans do not cover all dental procedures, especially those considered cosmetic. Before scheduling a costly dental procedure, workers should check with the insurance carrier to verify coverage. This information will help employees get the most from their dental coverage and avoid unexpected out-of-pocket costs.
Check if the dental plan has a waiting period before covering some procedures. The waiting period can be several months to a year. However, some dental insurance plans, through Ameritas, for example, offer day-one benefits. So members can start using their coverage on the first day of their new plan. To lower costs, some plans may offer a waiting period on Major/Type 3 procedures. It just depends on the plan.
In- and out-of-network
Most dental plans offer in-network benefits through participating providers who agree to accept a set payment from the insurance company for each covered service. For out-of-network providers, insurance plans usually cover part of the cost and members pay the rest.
Copays and deductibles
Many plans have a copayment or deductible. A copay is a set amount members pay at each appointment. A deductible is the amount members must pay before the insurance plan pays. Generally, there is no copay or deductible for preventive procedures.
Annual maximum benefit
Most plans have a maximum yearly coverage limit. This is known as the annual maximum benefit. It’s the amount insurance will pay each year toward dental claims on covered procedures. Beyond that, members would pay the rest. Usually, annual maximums range from $1,000 to $2,000. However, the American Dental Association reports that only 2.8% of people on a PPO Network Plan (Participating Provider Organization) reach their dental plan’s annual maximum. On the flip side, if workers need a lot of dental work and do use their entire annual maximum each year, it’s to their advantage to time dental procedures from benefit year to benefit year to get the most from their insurance.
Rewards and incentives
Some dental plan designs include a rewards feature where members can increase their annual maximum benefit over time. For example, they could qualify to carry over up to $350 in unused benefits that can be applied to future dental claims. Without this feature, the plan’s annual maximum benefit resets every year with no increase (rewards carryover). Employees should check whether the plan they’re considering has this feature.
Insurance carrier reputation
Before employees commit to a dental insurance plan, they should check the reputation of the carrier providing the coverage. Find out whether customers are satisfied with the coverage and how many customers stay with the carrier after the first year. Also, find out how long they’ve been in business and how fast they pay claims. A lot of this content can be found on the insurance carrier’s website or social media platforms.
Medical insurance with dental
Some medical plans include dental coverage. But the plan may cover only a portion of the cost for dental cleanings and checkups. Other dental expenses, such as fillings, crowns or root canals, may not be paid unless the medical deductible is paid first. A stand-alone dental plan usually provides better coverage that meets employee needs.
It’s safe to say that most people don’t like financial surprises. Before seeing a dentist, most people want to know the cost. Employees can learn more about how to estimate dental expenses so they will be prepared. It’s also a good idea to ask the dentist. Help employees know what to expect during a post-COVID dental visit by reviewing this blog.
American Dental Association