With the rising cost of insurance premiums, many employers struggle with the decision of whether or not to offer dental insurance to their employees.
There are three major categories of procedures to understand; all have different cost sharing breakdowns:
1. Preventative and Diagnostic Services: This generally includes two cleanings and oral exams per-year as well as a set of bitewing x-rays once every 12 months. Your dental insurance plan will typically pay 100% for these procedures and you pay 0%.
2. Basic Restorative Services: This generally includes silver fillings for cavities, tooth extractions and re-cementing of existing crowns and bridges, among other things. Your dental insurance plan will typically pay 80% for these procedures and you pay 20%.
3. Major restorative services: This generally includes bridges, crowns, partial and complete dentures among other procedures. Your dental insurance plan will typically pay 50% for these procedures and you pay the other half.
Corrective services: generally includes services such as orthodontia and isn’t included outright in most dental insurance plans. Plan coverage of these services can be purchased as a separate rider at a cost of a few extra dollars in monthly premiums. With the rider, your dental insurance plan will typically pay 50% for these procedures and you pay the other half. Also, dental insurance plans generally have a waiting period of anywhere from 12-24 months before corrective services are covered.
In/Out of Network Dentists
UCR (Usual Customary and Reasonable)
Almost all dental insurance companies use what is called a Usual, Customary and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $69 for a dental cleaning but your insurance company will only allow $58 because that is the UCR fee that has been set.
If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of pocket; however, you cannot put a price tag on quality dental care.
Reasons to consider dental insurance include but are not limited to:
1. Early diagnoses of systemic health conditions including osteoporosis, diabetes, kidney disease and cancer
2. Various other health benefits such as improved digestion and drastically reduced risk of both heart attack and stroke
3. Preventative care and treatment of dental conditions in their earliest stages, before they become painful and costly