Dental insurance facts


Facts & Fallacies of Dental Insurance

While the roles you and your dentist play in maintaining your oral health are easy to understand, the role of dental benefits is sometimes unclear. Insurance industry jargon used to describe your benefits often blurs the actual terms of coverage. We encourage you to be informed on how your dental benefit plans work so that you can make the most of your coverage.

Although dental insurance plans play a great role in promoting dental care; their individual policies have many limitations and restrictions.  We can submit predetermination request for the proposed dental treatment to your insurance so that you know the extend of your coverage.  Your dental insurance is based upon a contract made between your employer and an insurance company. Some insurance companies only communicate with you for privacy concerns. In those situations, should questions arise regarding your dental insurance benefits, it is best for you to contact your employer or insurance company directly.

Dental benefit plans help you pay for certain kinds of dental care. Your dental care decisions should take into account more than just what is covered. Your dental health needs can only be determined by you through consultation with your personal dentist. Good dental care is your right, and can best be attained by understanding your specific dental needs and how your dental benefits plan relates to them.

Dental insurance benefits differ greatly from general health insurance benefits. Unfortunately, the dental insurance limit has not changed or in some situations decreased considerably from a decade ago.  Many insurance companies impose a limit of $500-$1500 only per year.  Considering the rate of inflation and increase in cost of dental materials as well as labour and dental laboratories, most insurance limits are inadequate for even basic treatments. Your probably witnessed that premiums have increased, but your benefits have not increased, or in some cases decreased. Therefore, dental insurance is never a pay-all; it is only an aid.

Many plans tell their participants that they will be covered "up to 80% or up to 100%" but do not clearly specify plan schedule allowance, annual maximum or limitations. It is more realistic to expect dental insurance to cover 35% to 65% of major services. Remember, the amount a plan pays is determined by how much the employer paid for the plan. You get back only what your employer put in, less the profits of the insurance company.

Please do not hesitate to ask us any questions about insurance and our office policies.

How Well Do You Know Your Dental benefit??

  1. 1.What types of dental coverage are offered by your employer or union?

  2. 2.Which procedures does your dental plan limit or exclude? Do certain procedures have waiting periods?

  3. 3.How are your benefits calculated?

  4. 4.Does your plan allow pre-determination of benefits?

  5. 5.Does your plan impose an annual maximum benefit level?

  6. 6.What are your co-payments?

  7. 7.Does your policy cover only the least expensive alternate treatment?

Tips on Getting the Most out of Your Dental Plan

1. Read your benefits booklet. Dental health coverage is provided by your employer or union to help you handle the costs of staying healthy. Using them wisely is your responsibility.

2. Know your options. Be familiar with the exclusions and limitations of your coverage.

3. Communicate with your dentist, employer and insurance company. Keep everyone informed of your experiences.

4. Practice good oral hygiene. Follow the hygiene habits prescribed by your dentist.

5. Ask questions. Be a partner in your own dental health.

Common Types of Dental Plans

Indemnity: Indemnity benefits are expressed as a covered fee-for-service. This coverage allows patients to choose their own dentist. Limits and co-payments are set according to the level of coverage purchased by the employer or union.

Direct Reimbursement: Enables employers to offer cost-effective dental benefits while allowing employees the freedom to choose their own dentists. The patient receives prescribed dental treatment and is reimbursed directly by the employer.

Self Insurance: The employer assumes the role of an insuring agency.

Dental Care Service Plan: A non-profit organization of participating dentists who agree to charge enrolled patients fees which do not exceed a predetermined level.

Closed Panel: Offers a limited number of facilities, and a limited number of dentists from whom care must be obtained.

Capitation Plan: You're assigned to a specific dental office where contracting dentists receive a fixed monthly fee per patient regardless of whether treatment is performed (This type of insurance is not allowed in British Columbia).

Preferred Provider Organization: A group of dentists who contract with an insurance company to provide care at discounted fees.