Dental Insurance Policy

Because full coverage dental insurance has become an important part of household budgets, understanding a dental insurance policy is important for any potential purchaser.

Basically, a dental insurance policy is a contract between an insurance company and an individual or group (if an employer) in which the insurance company agrees to provide certain dental service coverage for a participant.

Generally, a dental insurance policy lists the name, plan type, policy number, deductible (if applicable), co-payment (if applicable), effective date, and coverage period. The policy will also list the dental services that are covered and what percentage of coverage will be paid. This is an important area that all participants should thoroughly understand. For example, most policies will pay for annual checkups and routine cleaning and the insured will not incur any out-of-pocket expense. However, a participant who has a root canal will have only a portion (up to 50 percent) of the service paid for; the participant will have to remit any remaining unpaid balance. Consequently, a participant should know which dental services are covered, how much of the fee is covered, and how much he or she will have to pay out of pocket for services.

Another area a participant should understand is the maximum annual or lifetime benefit. Many full coverage dental insurance policies will provide a maximum annual limit payable for dental services (ranging from $1,000 to $1,500) or a maximum lifetime limit that it will pay for services (ranging from $10,000 to $15,000). Knowing these limits is critical in determining when and how often participants may visit the dentist.

Many dental insurance policies will provide information about the dentists in and out of their networks. Dentists in networks are dental service providers who are under contract with an insurance company to provide pre-determined dental services for pre-determined amounts. Visiting a dentist in network will help a participant know exactly how much he or she will pay for certain services. However, participants who visit a dentist out of network run the risk of having to pay the difference between what the dentist charged for a service and what the company will pay for that service.

A final area of a dental insurance policy important to understand is the exclusion or limitation section(s) of the policy. Many policies will clearly list the dental services that will not be covered. For example, teeth whitening/bleaching is generally considered cosmetic and will not be covered.

 

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