Dental insurances are different than medical insurance. In general dental insurances have limited coverage than medical insurances. Two people may have same dental insurance such as, Delta, or Aetna, but depending on their plan, they will have different coverage. This usually depends on how the employer or the company the person works for negotiated with the insurance company. For example, company A and company B both offer dental insurances to their employees through Cigna insurance, but coverage for employees of company A will be different from coverage of employees of company B.
Here are some of the things to look at when selecting your dental insurance,
Yearly maximum: The maximum amount that the insurance company will pay for treatment in a calendar year. If the treatment costs more that the yearly maximum, patient pays the rest.
Deductible: This is the amount that patient must pay before insurance company starts to pay for the treatment.
Copayment: Amount that patient pays at the time of service depending on percentage coverage by the insurance company. For example, If insurance covers 80% of restorative, then for each filling, patient pays 20% of the fee. If Insurance covers 60% of the major services like crown, then patient pays 40% of the crown fee.
Missing tooth clause: If your insurance has missing tooth clause, it means that if a tooth was extracted or removed prior to start date of the insurance, the insurance may not pay for replacement of that missing tooth.
Out of Network benefit: If your insurance has out of network benefit, then if you see a provider who does not participate in your insurance, the insurance company may still pay entire of partial bill for the treatment. If you do not have out of network benefit, then your insurance will not pay for any treatment if you see a provider who does not participate in your insurance.
Ortho coverage: If your insurance covers orthodontic treatment or braces.
Ortho maximum: The maximum amount insurance company will pay for orthodontic treatment or braces. It is calculated separate from yearly maximum.
Ortho age limit: Beyond this year, the orthodontic treatment is not covered.
Implant coverage: If your insurance covers placement of implant and crown over the implant.
Waiting period: The time you have to wait prior to your insurance starts paying for the treatment.
In summary, when choosing dental insurance, one should have an idea of one’s current dental health condition, and possible dental needs, and be aware of what individual dental insurances offer. It is also beneficial to ask for a summary of benefit outlining all the factors mentioned above from the insurance company.