Dental insurance plans started in the 1960’s as a means for helping to pay for the cost of dental treatment. Labor unions promoted them in contract negotiations with employers. The effect of these plans was not to decrease the cost of dental care, but to make that cost tax deductible. The Internal Revenue service adopted a policy that the benefits would not be considered income to the employee.
Dental plans aren’t really insurance in the traditional way we think of insurance. Traditionally you are insured against catastrophic losses–for example– your home owners insurance covers you if you home or property is destroyed by fire, accident or a crime and you are reimbursed for the damage. Dental plans on the other hand, are geared toward providing a maximum fixed dollar amount of benefits every year. The insurance company needs to charge enough for the premium, pay your benefits and still have some money left over for operating expenses and profit. Dental insurance companies obviously have to take in more money than they pay out in benefits, this is just common sense. So, yes, they are skimming your dental dollar, but if you paid for the care yourself, you would be taxed on the money. It is the tax savings on the premium that keeps the industry going.
Dental plans limit their coverage of cosmetic procedures, they are usually disqualified from any coverage. The fact that you need to remember about dental plans is that it is not intended to cover all of your dental needs, it is a benefit to help defray the cost of treatment. Patients frequently ask, “What’s a good insurance company” or “What’s the best dental plan to have?” The answer involves keeping in mind that each employer negotiates with an insurance company to administer a dental plan and pay out benefits–they determine together what your maximum will be and what services will be covered.
If your interested in knowing more about your insurance, feel free to give the office a call and we can discuss your current plan and benefits or review what your choices might be for a new plan if you have recently started a new job.
The insurance puzzle continues. The world of insurance changes frequently, partly because employers are looking for ways to cut costs so they can still offer benefits to their employees and partly because the insurance companies are offering suggestions of cost cutting measures.
Why are some services not covered by my insurance? Your employer determines what services will be covered and the percentage of coverage for each procedure. The insurance company is just administering the plan. Many times procedures that are considered cosmetic, or an upgrade from what would be considered the minimum treatment to restore a tooth’s function are not covered. A good example would be a back tooth that needs a filling. Dr.Shlafer would recommend a white tooth colored filling, and many insurance plans still cover for a silver mercury filling. In this case, you would be responsible for the difference. This is an example of a cosmetic upgrade. Most patients want non metallic restorations in their mouths and love having a tooth that appears to have no dental work on it.
Another popular question involves frequency limitations. Once again, the employer determines how frequently services can be done. A common example would be for a periodontal patient, this patient comes every 3-4 months for hygiene visits and wonders about coverage for their extra visits to care for their periodontal condition. Many plans only allow coverage once every 6 months, or 2 times within the contract year. This is why the patient becomes responsible for the 1-2 necessary additional visits.
Checking insurance benefits does require personal information. It is understandable that patient’s want to protect their personal information, and many insurance companies are using random ID numbers to locate your benefits. Unfortunately many still require the subscriber’s social security number, employer’s name, subscriber’s date of birth and the patients date of birth. We take every precaution to protect your personal information. It’s always a good idea to become familiar with your dental plan, so you are aware of your coverage details.
Insurance enrollment is just around the corner. Take a moment to read over your benefit choices. We are always available to answer questions. More on insurance–stay tuned.
Patients frequently ask many questions about their dental insurance. It can be confusing and sometimes overwhelming trying to understand your plan benefits so, let’s try to unravel the mysteries of the insurance world together.
- What does” insurance maximum” mean? The maximum is a dollar amount (for example $1000.00) determined by your employer that can be applied to your covered dental procedures. This amount is available to use during your contract year.
- Is the maximum for my whole family? No. Each eligible family member receives their own yearly maximum.
- When is the contract year? This is decided by your employer, and can run from January 1st through Dec 31 st-commonly referred to as a calendar year, or any month for example June 1st through May 31st is referred to as a fiscal year.
- Can we use other family member’s maximums? No, unfortunately there is no sharing of maximums.
- If I do not use all my insurance money will it carry over to next year? No. Whatever insurance money is not used during your contract year is lost.
- If I have a $1500.00 maximum, can I use this whole amount for one service? No. Insurance plans are set up with 3 different categories or levels of coverage. One is preventative–two is basic –and three is major. Each one of these categories is paid at a specific percentage of coverage. For example: a healthy mouth cleaning may be covered at 100%, whereas a root canal may be covered at 70%, and a crown might be at 50%.
- Aren’t preventive services covered no matter what? No. Even if your contract states coverage at 100%, you must have money available in your current maximum to cover the visit. All services are subtracted from your maximum.
Join us tomorrow for more information regarding your insurance policy. Please feel free to submit any questions you may have.
Are you aware of the upcoming insurance changes ? As you know, your contract has always been June 1 to May 31 of each year, FORD is changing this so you will no longer be on a fiscal year but switch to a calendar year. On June 1,2010 the pro-rated maximum of $875.00 will begin and last through December 31,2010, your flex account will remain the same. If you have dental treatment to complete, this would be a great time to take advantage of this additional funding. In January of 2011, your full maximum of $1500.00 will be re-instated. We are always available if you have questions regarding insurance choices or need help planning for flex spending.