1. What are dental insurance plans?
Dental insurance is similar to any other type of insurance wherein the insurer needs to pay a monthly premium for the dental coverage. The dental coverage is directly related to the insurance policy cost. All the dental insurance plans aim to compensate dental treatment costs. Generally these insurance plans cover up to $1200 to $1500 of dental treatment costs per year. All the plans differ in the level of compensation offered.
2. Who can apply for the dental insurance?
Anyone who is 18 years or older and dependents can apply for the dental insurance. There is wide variety of dental insurance plans available in the U.S. that covers – couples, individuals, families, and seniors.
3. What are the different categories of plans on offer?
To understand the full benefits of your dental plan, it is important to understand the different features of each plan. The following are some of the categories of the dental insurance plans:
• UCR (Usual, Customary and Reasonable) plans: The main benefit of these plans is that they let you visit the dentist of your choice. These plans pay a preset percentage of the dentist’s fee or the administrator’s “reasonable” or “customary” fee limit, whichever is less. There is no standard fee or accepted method for determining the UCR, each plan administrator determines the fees.
• Direct Reimbursement Plans: These plans compensate the insurer a percentage of the total treatment cost on the dental care, irrespective of the category of the treatment. These plans also allow the patients to consult their own dentists.
• PPP (Preferred Provider Organization) Plans: Under these plans a group of dentists on the panel agree to give a discount on their fees as an incentive. Though if an insurer’s dentist is not a part of the group, the insurer will have reduced or no benefits.
• Schedule of Allowance Plans: These plans determine a list of covered treatments with a set dollar amount. The amount represents what the plan will pay for the treatments that are covered. If the dentist’s full charge is not covered under the amount, the insurer will have to pay the difference.
• Capitation Plans: These plans pay the dentist a fixed amount per family or an individual usually on a monthly basis. In return, the dentist provides specific types of treatment to the patients free of cost.
4. What does the dental insurance plan cover?
Before going for any plan, this information is very important and it should be provided by the provider, be it your employer or the insurance company that you have chosen. To understand what all benefits are available to you under the plan, the plan should clearly define the limitations or exclusions, the benefits, extra charges or any other terms and conditions. All these should be checked before opting for any treatment.
5. How long does it take for a claim to be compensated?
This generally varies with different insurance providers. There are at least 38 states that are covered under the law that suggests that the insurance claims are to be paid within a timely period (generally between 15 to 60 days).
6. What to do if the treatment that the dentist suggests is not under the plan coverage?
Some plans only provide the level of benefit allowed for the least expensive way to treat a dental problem. The dentist can explain the importance of the treatment to the insurance company but there is no guarantee that the company will pay for the treatment. In such cases, the insurer should base the treatment decisions on the dental needs, not on the dental insurance plan.