Dental Insurance

By Staff Writer DiscountedDentalCard.com

Many employee benefit plans include insurance coverage for dental and vision care.  This motivates employees to keep current with annual and sometimes semi-annual vision and dental checkups. These every-year/semi-annual checkups are important for an overall comprehensive health program.  The population not covered by insurance and required to pay the full fee schedule will only visit the dentist or optometrist when they experience a problem.  This often leads to, what could have been perhaps only a minor problem if caught early, major dental or optical maladies costing big dollars.

What can individuals and families do when faced with a future of no insurance to cover dental and vision care? 

Well they can apply individually or as a family to an insurance company for what are commonly referred to as non-group individual or family policies. Generally the premiums are substantially higher than group rates.  There also is an underwriting procedure whereby the insurance company assigns an agent to interview all applicants regarding their health history and current health condition. All doctor visits, hospital stays, existing and past health problems and surgeries are documented in an application for insurance and sent to an underwriter assigned to the case.  The underwriter will review the application and decide if further information is needed to evaluate the risk.  Many times more information is requested from doctors, hospitals and clinics.  A nationwide database of medical information is accessed to determine if all applicants have made a complete disclosure of their health history and condition.

The Underwriting Process

Once this information is obtained the underwriter determines if all, some or none of the applicants qualify for coverage under the current underwriting guidelines for the insurance policy applied for. One of many decisions can be made at this point.

 * Coverage can be denied altogether.
 * Coverage is granted except for certain preexisting health conditions.
 * Preexisting health conditions can be exempted for life or for a period of months or years.
 * Policy premiums can be increased or "rated" due to the health history and condition of the applicant
 * A waiting period of months before coverage begins can be amended to the policy.
 * The policy can be issued as applied for without waivers or ratings.
 * The policy can be canceled or the premiums increased in future policy annual renewals.

Paying Claims

Once the policy is issued and coverage begins the insured will have to deal with a deductible before coverage begins. This can be several hundred or even several thousands of dollars of covered expenses before the insurance company is subject to any claims.  Once the deductible is met the insured is responsible for a portion of the bills, usually 10 to 20 percent.  Sometimes a stop loss provision applies stopping the insured from any additional "coinsurance" liability after out-of-pocket expenses reach the stop-limit amount. There also can be an annual cap fixing the maximum amount the insurance company will pay. This can be as low as $750 to $1,000 dollars. All expenses must be submitted to the insurance company on claim forms submitted in a timely manner. Often times the care provider will fill out the claim forms but as often the patient is required to.  The payment for the covered dental or vision medical expenses is sent directly to the care provider.

Providers

Insurance policies will generally allow the policyholder to go to the dentist or optometrist of their choice. However sometimes they restrict their policyholders to a list of providers on an approved list.

Should you apply for dental insurance or become a member of a dental discount plan? There are big differences. For information about Dental Plans vs. Dental Insurance. Other resources for dental insurance.