Insurance Part 3: Dental

Insurance

Part 3: Dental

By Keith Bunn Jr.

August 19, 2012

OK, I think every one of us can admit that going to the dentist is not the most favorite thing to do, but in my opinion, going to the dentist it is an absolutely “must do” thing that every one of us should do for a number of reasons.

1.    To prevent gum disease.

2.    To prevent oral cancer.

3.    To avoid losing your teeth.

4.    To prevent dental emergencies.

5.    To maintain overall good health.

But we also know that going to the dentist isn’t cheap. Not just for the reasons listed above, but because of all the other things not listed. Fillings, Crowns, Braces, etc… are just a few things that can be quite costly if you don’t have a good insurance plan in place.

But are all plans the same?

Well, in my research, I came across a website from Amerites Group and it is clear that the answer to that question is no. On their website they have come up with these 10 points to look into.

1.    Coinsurance and Copayments: What is the coverage in and out of network? For PPO plans, know what percent the plan pays by procedure category, typically stated as preventive basic and major. If the plan has a copay structure, know the member costs for common procedures.

2.    Deductibles and Maximums: If the plan has a deductible, when does it apply and what is the amount? Is there a maximum number of deductibles that can be charged per family? What is the annual benefit maximum available per year? If orthodontia is included, what is the lifetime benefit available?

3.    Procedure Placement: In which category do typical procedures fall? Most carriers move procedures into different categories, such as x-rays, root canals, gum disease treatment, or oral surgery. If you are working with a PPO, it is crucial to know if these procedures are classified as preventive, basic, or major as this will impact rates and out-of-pocket costs for insured.

4.    Procedure Frequencies: How often can each kind of x-ray be taken? How many cleaning are permitted per year? How many years are allowed between crown replacements? For example, one carrier may approve replacement of crowns every five years while another may extend the limit to ten years. You need to know these details for each plan under consideration.

5.    U&C Allowances: What “Usual and Customary” allowance is used for out-of-network providers? Not all 90^th percentiles are created equal. The 80^th percentile for one carrier may equal the 90^th for another. Know how the carriers compare, the source of their U&C data and how they update their records.

6.    Special Coverage: Does the plan cover dental implants? What about composite fillings in molars? Does the orthodontia cover adults? Producers need to know this information.

7.    Value Stretchers: Dental plans have come a long way in the last ten years with innovative features, such as carry-over maximums, sharing dollar maximums within the family, and excluding preventive procedures from the maximum. Many plans also offer significant vision, hearing, Rx, and other benefits packaged with the dental. Know what extra incentives are built into the plan to help stretch the available benefits.

8.    Waiting Periods and Participation: What procedures require a waiting period before employees can access benefits?  Is the policy different for current employees and new hires?  What participation percentage of eligible employees does the carrier require?

9.    Network Access.  If the plan design includes a dental network, are there enough contracted providers close to the employer: Producers should know how the carrier counts the network participants, including the difference between access points, providers and locations.

10. Commission. What commission is included in the plan quotes? Do not assume every carrier is quoting the same, or that they are quoting what you asked for in an email. Find out.

After you compare the plan components, look at the rates for each plan. Also, if you have the opportunity to have more than one dental plan, make sure both insurance companies will coordinate benefits. This means, one insurance company will pick up coverage where the other one left off at. Make sure you know this information before starting the 2^nd insurance company because if they don’t coordinate benefits, it makes no sense having the  2^nd one.

I hope my posts inspire you to look at what you’re doing financially and if needed, make some changes that will cause you to win financially. I also look forward to reading your views on any articles or postings that I may post. For more money news, facts and ideas, follow me on Facebook, or Twitter. Thanks you!