Supplemental Dental Health Insurance
Supplementary (or individual) dental insurance means that you obtain your dental insurance directly from a dental insurance company rather than being part of a group run by the employer or the state.
Supplemental (or individual) dental insurance means that you obtain your dental insurance directly from a dental insurance company rather than being part of a group run by the employer or the state.
You may opt for supplemental dental insurance if you are worried that your current insurance will not be sufficient to cover all your dental costs or if you move around a lot or change employment frequently.
Supplemental dental insurance is becoming very popular because the workplace is no longer the same as ten or twenty years ago. Most people now do not remain with the same employer for life. Hence, the insurance plan has to follow the employee from job to job.
Supplemental dental insurance is therefore suitable for these people. However, as many people looking or individual plans will find, dental insurance companies are very reluctant to provide insurance directly to clients. The reason behind this is that, unlike with other insurances (e.g. fire or health), dental insurance does not yield so much profit.
With fire insurance on the home, the company stands to make a profit as there is little chance that your home will burn down. However, with dental insurance this is not so. Most people will need a dental appointment every six months.
The company cannot claim more on premiums as the patients would not agree to pay more than what they would incur as dental costs. Hence, companies just end up with making a loss. Still, if one looks hard enough, there are several types of supplemental dental insurance plans, as discussed below.
1. Discount or Referral Dental Plans
At first sight, this does not resemble dental insurance at all! Referral dental plans simply that the insurance company has a network of participating dentists who have agreed to provide discounts on teeth treatment to the clients of the company. The patient pays a fee to the company but also pays the dentist directly at the discounted price. Of course, the patient has no possibility of choosing a dentist of his/her choice. He must imperatively choose a dentist from the network of the company.
2. Indemnity Dental Insurance
This is a traditional dental insurance where the insurance company pays the dentist for the services administered to the client. In some cases, the company may pay the dentist in full but this is rare. In most cases, the dental insurance company covers between 50 to 80% of the dentists’ fees.
The advantage of Indemnity dental insurance is that the patient has the freedom to choose his dentist. There are usually two types of Indemnity Dental Insurance, depending on the way the insurance company calculates the amount of payment to be made:
- Usual, Customary and Reasonable (UCR)—the dental insurance company has a price list (the UCR price) for all dental procedures. If your dentist charges equal or less than the price on that list, then the dental company will pay 80% of the dental charges. If the dentist charges more, then the company will pay 80% of the UCR price. The disadvantage for the consumer in this deal is that the company can quite arbitrarily set the UCR price, which thus would not reflect the reality of prices. There is no regulation of how dental companies calculate UCR fees.
- Table of Allowances—the dental company sets a list of all dental procedures covered by the dental insurance plan. The company states what amount it would pay for every dental procedure. If the dentist charges more than the allowance (as it invariably does), the patient pays the difference to the dentist.
3. Managed Care Dental Insurance Plans
Managed Care dental plans are very popular because they are quite cheap. If the patient selects a dentist that forms part of the network of the company, there is no need to pay the dental fees upfront. Moreover, the client will benefit from discounts as part of the dental insurance coverage. There are several types of Managed Care Plans:
- Preferred Provider Organization (PPO)—a dental network is established by the company. Each dentist of the network will give the client of the company discounts. The client can still opt to see a dentist outside the network but it will cost him more to do so.
- Dental Health Maintenance Organization (DHMO)—the dentists in the network offer discounts because the company has offered them a prepayment. In such plans, the client can only choose the dentists in the network.
- Dental Point of Service (POS)—this offers the client a choice between dentists who are part of the network or those who are not.
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