Do i need dental insurance?
For example, most dental insurance will offer $1000.00 cover per year, but the fact is that most patients never require more than $100.00 per year. Self funding might be a better option as it removes the dental insurance overheads.
The employer option
But if something goes wrong then you might need a comprehensive dental insurance cover or access to funds that you might not have.
This is why some employers offer Direct Reimbursement (D.R.), the employer takes a percentage of salary into a dental insurance fund and this covers the employees.
The insurance companies response
To offer cheaper dental insurances than the one offered by employers, insurance companies responded with HMO's and Preferred Provider Plans (PPO's). Under those plans the insurance can offer cheaper premiums, but the treatments offered are often very limited. Another problem is that the dentists often increase the waiting lists and limit specialist treatments.
The common options
Although the employer dental insurance is often the better option you need to look at that they actually offer you.
Who will select the dentist?
- Open Panel, you choose the dentist without any restrictions.
- Close Panel, you are given a list of dentist to select, they in turn signed an agreement controlling their charges with the dental insurance company.
- Preferred Provider Organization (PPO), Group of dentist that offer to charge less, if you want someone else, you might need to pay the difference.
- Exclusive Provider Organization (EPO), Group of dentist that offer to charge a lot less, but then the client cannot go anywhere else, (unless they pay the full price).
How is the dentist compensated?
- Payment plan, the patient pays a monthly fee to the insurer and in turn the insurer pays the dentists/specialist.
- Capitation Plans, the dentists charges the insurance company a certain amount per-capita, (per patient), and in turn offer to treat the patient.
- Direct Reimbursement Plans, the patient pays the full price and the dental insurance plan will reimburse all or some of the money.
All above can limit the percent value that is actually been repayed and/or cap the yearly value that can be (re-)claimed.
How are the benefits and payments calculated?
- A list is given of what is covered and for how much, any amounts over are not reimbursed by the dental insurance.
- The dental insurance offers a maximum amount that can be reimbursed per year, as long as the patient is within that figure the insurance will cover them. This is great for long term treatments, allowing the patient to choose the best value for money and overall treatment for their need.
What to look for in a dental insurance
When choosing a dental insurance you should always choose the best option for you, make sure you look at more than one option and choose what is best for your family.
Some of the basic items to look for in a good dental insurance are,
- Freedom to choose who you want. What if your family dentist is not covered? What if you are nervous at the dentist, can you choose someone else?
- Who controls treatment decisions, you should be able to talk to your dentist about what is best for you.
- What is covered by your dental insurance? Read the small print, diagnostic and preventive treatment is not the same as emergency treatments. All should be covered.
- What are the basic services that are fully covered? Some treatments, (mostly preventative ones), are fully refunded. Does your dental insurance clearly indicate what they are?
- Initial examination?
- Bi-annual investigation?
- Preventative care should be covered, but what about treatment that ensure optimal dental health? Tooth removal for example or repair of existing denture, bridges etc...
- If major, (emergency), work is needed are you covered? Surgical work or dental implants and so on...
- Specialist referral? What if you need to see a specialist, does your dental insurance offer a panel of approved specialists in your area? If not what happens? Are only general dentists covered by the insurance?
- Are the dentists on the panel able to offer flexible appointments that suit your hours? Or does a special agreement with the insurer restrict when and where you can see the dentists?
- Check what happens if you are covered in more than one place, it is not uncommon to have more than one dental plan. Can you get credit if you don't use a certain plan? Can you join both plans? How can you use them together?
- How clear is the plan? For example, in some states in America the law mandates that consumers with dental coverage receive a fully detailed patient information handbook. Is it clear enough?
