Dental Insurance Features

By Susan Braden
Published Sep 02 2010

Finding a dental insurance plan is no easy task. As you investigate dental coverage, it is vital that you understand the components that make up dental insurance plans. By doing so, you can make sense of the sometimes confusing terminology.

Types of Coverage

In general, there are three types of dentistry that insurers can cover to one degree or another. Be sure you know exactly how your potential insurer classifies various procedures.

• Preventive procedures usually include routine examinations and teeth cleaning, and usually x-rays and fluoride sealant treatments.
• Restorative procedures usually include fillings, extractions, and root canals.  
• Major procedures include crowns, implants, complex extractions that require surgery, partials and dentures.

Waiting Periods

Ask yourself if you need dental coverage for a major procedure right away. If you do, you may run into a waiting period, a sticky component of many dental insurance plans. According to this clause, you may be required to wait several months to a year before receiving coverage, paying premiums all the while. Before signing on the dotted line, make sure you are fully aware the extent of these periods.

UCR

This acronym refers to a Usual, Customary and Reasonable (UCR) fee guide set by many dental insurance companies. This fee is the amount that your insurer will actually pay your dentist for a procedure. For instance, though your dentist may charge $80 per cleaning, your insurer may have determined that $60 is “usable and reasonable,” and only cover that much. If you are seeing an in-network dentist, you may not be required to pay the difference between the dentist’s price and the UCR fee. However, if you go out of network, you should find out if and how much you will be charged out-of-pocket.

Yearly Maximum

This term refers to the maximum amount your insurer will pay toward your dentistry expenses within a 1-year period. If you do not use your entire amount, it will not roll over into the next year. On average, insurers allow a yearly maximum of only $1000.

Deductible

This is the amount that you will have to pay out-of-pocket (even though you have begun to pay premiums) before your insurance will begin to cover your procedures.

Missing Tooth and Replacement Clauses

Most insurance plans contain one or both of these restrictions.

• A missing tooth clause protects your insurer from having to pay the cost of replacing a tooth that was lost before you purchased coverage. In other words, they will not cover the cost of a new bridge, implant or partial on a tooth that you did not have at the time you signed up for coverage.

• A replacement clause stipulates that the insurer will not pay for replacement bridges or other procedures until a stated time period has passed.

Cosmetic Work

Procedures such as tooth whitening that are performed only to improve the appearance of your teeth fall into this category. Cosmetic dentistry has become very popular in recent years. However, keep in mind at least 99% of insurers will not cover it.

In-Network vs. Out-of-Network Dentists

If you are loyal to a particular dentist, find out your potential insurer’s policy on in-network and out-of-network dentists. Some companies will only allow you to see an in-network provider, while others give you more freedom of choice, albeit often at a higher cost to you.

Why the Red Tape?

Insurers can use the limitations of UCRs, maximums, deductibles, and fine-print clauses to ensure they receive more money from you in premiums than they will pay out in claims. Take the time to research if dental insurance plans will adequately address your oral needs, and carefully check if a plan offers coverage for the procedures you will need in the foreseeable future

Choosing the Best Dental Coverage

Choosing the coverage that’s right for you can be confusing process.  Because traditional dental insurance plans can cost money and hassle, don’t hesitate to investigate all of your options. Discount dental plans, without many of the limitations of insurance, allow patients savings that often surpass their low monthly fees. As you research dental coverage options, take the time to see how much money a discount plan such as the Careington 500 Series could save you and your family.