Dental plans are probably the second most
popular benefit behind health insurance.
It may also be the benefit causing the most confusion for many employees. In some ways, dental
benefits work like health insurance benefits, but there are differences. In order for any benefit to work smoothly,
the employee needs to be diligent and understand his/her benefits to insure he/she
receives the expected quality of care at the expected out-of-pocket cost.
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Like health insurance, most dental plans have
both in-network and out-of-network benefits.
But unlike health insurance, where the majority of providers (doctors) and hospitals
are in-network, the percentage of participating
dentists (in-network) is much lower with dental insurance companies relative to
the total population of dentists.
The out-of-pocket expenses will probably be what one expects if a
participating dentist is seen. But if you see a
non-participating dentist, you will probably be “balance-billed” and pay more
than what you expected. Employees should
be encouraged to choose a reputable participating provider with any Health and Welfare plan. There are available dental plans
that will minimizing the balance-billing problem with non-participating dentists.
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Another difference between dental plans and health insurance
is the cap on annual benefits. Most
health insurance plans either do not have an annual cap or have a very high
annual benefits cap. If
you have a catastrophic health condition, the health insurance plan will cover
all medical service expenses unless a service is not covered. Most
dental plans have a relatively low cap on the claim amount it will pay each year – most ranging from $1,000 to $2,000. As an illustration, a root canal (estimated at $1,200) and a crown
(estimated at $1,000) in one calendar year would meet the $1,000 annual benefit paid out by the
dental plan. If you have a $1,000
plan, the plan will pay $1,000 in claims, but the employee will be
responsible for 100% of the expenses exceeding the annual cap without any cost sharing with
the dental insurance company. The annual maximum will reset each year (usually based on the calendar year regardless of when your anniversary date is).
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Does
your dental plan have an open enrollment period? Most dental plans do not meaning employees who do not enroll when
eligible will not be able to enroll late (even on the anniversary date of the
plan, without (1) a qualifying event, or (2) an impairment rider
requiring an 18-24 month waiting period for Basic and Major Services.
Are your
employees instructed to ask for a pre-treatment plan before having a procedure
done? Not all carriers require a
pre-treatment plan from participating providers and a non-participating
provider will absolutely not be required to present one.
If a pre-treatment plan is not requested, you are gambling that the
carrier will cover (pay for) the entire procedure.
Did
you know for a small additional premium, endodontics, periodontics, and oral
surgery may be classified as a Basic Service rather than the default, Major
Service? The change may result in a
difference of paying 20% of the total charge rather 50% of the total charge. Or 20% of a $1,200 root canal rather than 50% of a $1,200 root canal.
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For more information, please contact Bridgeport Benefit Advisors.
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The material on this page is intended as general
descriptions of the concepts presented.
It is for educational purposes only and it not intended to provide
specific financial or tax advice. These
descriptions cannot take into account your specific conditions and situation
including the data required for underwriting purposes, financial circumstances,
risk tolerance, and other factors.
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