For healthcare buyers, dental insurance could often turn out quite a perplexing and frustrating affair. And that is primarily because the insurance plan usually doesn’t offer benefits or a level of coverage that the insured would have expected to start with. The word ‘insurance’ is typically considered synonymous with ‘protection.’
An insurance cover is a hedge that is usually purchased to lighten our financial burden that may be courtesy large, unforeseen expenses. For example, the losses incurred as a result of a car accident, injured or broken leg, or house fire can be significantly offset by a medical, homeowners or any other type of insurance applicable. And this is why people expect ‘dental insurance’ to offer benefits on similar lines. However, dental insurance is a different breed of insurance altogether. Let’s learn more.
Dental insurance isn’t devised to protect against certain risk factors or safeguard you from unexpected expenses. And that is because, unlike auto accidents, medical requirements, and house fires, dental costs are a lot more predictable. For optimal dental health, visiting the dentist twice a year (at least) is mandatory. Dental insurance will help you if you resort to good teeth care. Therefore, instead of safeguarding you from unforeseen expenses, dental insurance is designed to foot your “anticipated” dental bills.
Thanks to this predictability, the majority of dental insurance firms know what to expect from their claims, which makes it easier to sell the plans.
Fee-for-service dental insurance plans are probably the most common wherein you select the dentist, and the dental bills would be completely or partially shouldered by the insurance company for a fee ascertained beforehand in the policy agreement.
This is how things work. The insurance firm charges your employer a premium for every employee and covering their dental requirements, assuming that only a minor section of the employee population would capitalize on or need the cover. The premiums are derived based on the coverage type being chosen by a firm. The premium goes up with increasing coverage. The dental procedures covered, the fees, etc. are agreed upon in advance by the insurance company and your firm. But that won’t, in fact, be the dentist’s actual charges for a particular procedure, in spite of the reimbursement level is claimed to be UCR (usual, customary, and reasonable).
In other words, you would have to shell out more money. And this depends on the amount of cash your company is okay with putting on the table for employee dental care, along with the deal worked out between the insurance firm and your company.
Dentists are aware of the financial constraints of their patients and, therefore, try their best to assist them with treading their policies to arrive at a workable solution. However, your employer cannot permit an insurance firm’s rules to determine your treatment requirements.
The priority of any dentist is not to save money, but the patient’s dental health. When treatment is recommended by the dentist that the insurance won’t cover, the patient usually feels caught in the crossfire.
Dental insurance invariably is an incentive certain employers provide in different forms to entice and keep employees. However, businesses can only stretch so much with their employee benefits plans, particularly considering the current health of the economy. Though they would any day prefer healthy employees who show up every day to work, profit is still and would always be the most significant priority. They would provide what they think is feasible, letting the employee decide on the rest.
A Business Arrangement
You would at times require your dentist’s and his staff’s help to comprehend your insurance cover and arrive at sound decisions that would prioritize your health.
The actual dental plan constituents hinge on what the negotiations were like between the insurance firm in charge and your employer. This business arrangement is likely to have little to even no real focus on what your actual dental needs are. You would at times have to seek your dentist and his team’s assistance to comprehend your plan and arrive at decisions that would give maximum importance to your health. Remember, most dental insurance plans are not extremely particular about maintaining optimal health of the insured.
Preventive services such as cleaning the teeth two times a year, fluoride treatments and exams, etc. are dental procedures that most dental plans cover completely. Because these procedures are relatively inexpensive, saving expenses in the long haul by promoting healthy teeth and gums. Other health dental benefits, on the other hand, could vary widely.
You could discover your plan covering only 50 percent of the dental costs for a crown, excluding a lot more expensive yet extremely beneficial services like implants that are covered entirely. There would also be deductibles that you must pay for on your own before seeking any benefits. There is also a maximum sum that your insurance cover would remit each year.
Dental Insurance Consultation
Dental insurance works almost contrary to car insurance. An expert states if a car insurance cover worked like a dental cover, then the tune-up and oil change will get covered 100 percent; tires, shocks, and batteries will be reimbursed by 80 percent; and road mishaps would get reimbursed by 50 percent, with the maximum annual cover limit being $1,000.
If you are considering purchasing a dental insurance policy by yourself, then you must know that it’s not worth it at all. An average individual without a dental insurance cover would spend close to $200 every year on basic dental treatment or care. The yearly dental insurance premiums could run into $500 or even more. Then, the patient must also pay the deductible before receiving reimbursement of any form.
The annual maximum cover a patient can expect to receive from the policy would usually be anywhere between $1,000 and $1,500. It is important to take note of the fact that the cap benefit levels have not changed in decades, despite dental care expenses steadily increasing over the years in places such as Edmonton.
This post comes from our friends at Edmonton Health and Dental Benefits – Gold Key Benefits Group Edmonton. They can be found here:
Gold Key Benefits Group Edmonton
4732 91 Ave NW, Edmonton, AB T6B 2L1