Dental insurance is an important incentive for many people in the workforce, but there are many instances when an employer doesn’t provide adequate coverage. For example, some dental insurance programs do not cover orthodontic work, while others provide full coverage. Some companies offer dental coverage plans that will only address toothache relief with tooth extraction, but will not cover tooth fillings or root canals. It all depends on the type of dental insurance plan offered by a worker’s employer.
Employers can offer their staff a few options in dental plans, which may include an HMO, PPO, or a simple “wrap around” coverage plan that works in cooperation with other coverage plans. Choosing the correct coverage plan can be difficult and even intimidating, but if an employee is handed the correct information, the choice between types of dental insurance plans can be quite easy.
Dental insurance that is based on the HMO (Health Maintenance Organization) option provides many benefits, but some additional rules apply when compared to other plans. For example, the employee who is provided coverage has a choice between only select dental practitioners that are part of the HMO. The employee usually decides which dentist they will use; at the time they start to receive dental coverage.
One potential drawback to the HMO plan is that there are higher fees, when an emergency dental procedure becomes necessary and the covered employee cannot use one of his or her HMO-approved dentists. The HMO system is usually not a problem for routine dental work, but may become a problem for an employee that needs emergency dental care. If a claim comes to the insurance company, they may refuse the claim, because the dental practitioner was not part of their HMO network. However, this is an extreme situation.
Many HMO companies also offer dental care providers that will be available in emergency circumstances, or the insurance company will provide coverage for a dental emergency if the insured agrees to an additional premium. In some cases, the insured patron must make sure that in such a situation, they still utilize a practitioner that is within the HMO network. HMO consumers should know in advance what their options are if an emergency dentist is needed.
Another option is to receive dental coverage through a PPO (Preferred Provider Organization). With this option, the employer allows the employee to choose the dental provider they want to use. The dentists do not have to be within the network of the PPO, and it provides the insured a good option for employees who have been within the area for some time and have a good relationship with their current dental care provider. It should be noted that usually the out-of-pocket costs are generally higher when utilizing a practitioner that is not within the PPO network.
If the employee chooses the PPO option and uses a dental practitioner that is affiliated with the insurance company, then the out of pocket costs are sure to be lower than using a practitioner that is not affiliated with the program. Another advantage with the PPO option is that sometimes the employer may add additional benefits to the plan such as orthodontic coverage. This is a major benefit for employees with young children that may need the help of an orthodontist in the future. With this type of option, the employee usually must use a participating orthodontist in order to receive all the benefits from the plan. The PPO purchased by an employer is different for every organization, so it is important for an employee to research the options available to them.
Another type of plan offered by employees is sometimes called a supplemental plan. In order to get this type of plan, an employee must already have a health plan that includes some dental services. The supplemental plan provides for any benefits that the regular health plan does not cover, so that the employee is provided with full dental coverage for all services that they may need.
With many supplemental insurance packages, the primary health plan usually must provide diagnostic and routine preventative benefits and then the supplemental plan fills in the rest of the dental coverage for an employee, such as crowns, fillings or an emergency dentist visits. These are non-routine procedures and the supplemental plan was designed for employees that need these types of services, but cannot receive them because their health plan does not cover specific dental procedures. The supplemental plan usually requires an employee to sign up for the plan and use the preferred providers that are affiliated with the insurance company. This is a good option for those employees that have a good health plan with routine dental benefits, but may need additional coverage for further dental procedures.
Dental insurance can provide an employee with the coverage needed to keep an entire family with beautiful, healthy teeth without large out of pocket expenses. The HMO provides dental care through preferred providers that help keep the expenses for the insured low. A PPO offers the added flexibility for an employee to choose the dental practitioner of their choice, while a supplemental plan works in cooperation with an employee’s already existent health plan, which provides for routine dental procedures to cover additional dental coverage needs.
Dental insurance plans can be confusing, but fortunately, with the proper information, an employee can choose the dental plan that will best represent the needs of their family.
