Dental Insurance II

    We are not quite sure what the correlation is between the first few signs of spring and dental insurance, but this past week, with the warmer temperatures, and crocuses starting to pop up, we have received a flurry of phone calls about dental insurance!

    Dental insurance is no different than your auto insurance. You can’t wait until you have an accident and then purchase auto insurance and expect it to pay for your accident. The same is true for your dental coverage; you must have the policy in force for a certain number of months before it is going cover any major dental expenses. You simply can not wait until the dentist tells you he wants to do a $1,500 root canal and then purchase a dental plan and expect it to be covered.

    Dental Insurance, at best, is mediocre. It is a rare day when we see dental coverage that is all inclusive. Really good dental coverage is usually only offered by some employers and by some unions. The majority of people have to settle with a mediocre policy that puts limits on how much the contract will pay each year and for each type of service. Generally speaking, if you can obtain dental insurance through your employer, the plan will be somewhat better than dental insurance that you purchase on your own.

    Some of you may have dental coverage through a DMO (Dental Maintenance Organization). A DMO is the same as an HMO only the HMO (Health Maintenance Organization) pertains to benefits for your medical expenses whereas a DMO provides coverage for your dental expenses. It is a managed care plan and it means you choose a dentist from the participating dentist in the DMO plan. You can only see dental specialists if you are referred by your primary care dentist. If you decide to go out of the network and choose your own specialist, most DMO plans will require that you are responsible for all out of network expenses.

    Dental benefits are usually divided in four categories.
        1. Preventive dental services which include exams, x-rays and cleaning.
        2. Basic dental services include fillings, extractions, and oral surgery.
        3. Major dental services which include crowns, bridges, dentures, root canal, and perio surgery.
        4. Orthodontic services which are in a class by themselves and may or may not be covered under your dental plan.

    For those of you not able to participate in a group dental plan, you may purchase an individual dental insurance policy, but there are limitations. Most individual policies that you purchase will have a waiting period for basic dental services and a longer waiting period for major dental services. For example, Baltimore Life Insurance Co. offers an individual dental policy that you can purchase on your own. The most it will pay per calendar year is $1,000 per person. Preventive services are paid at 85 % after a $50 calendar year deductible and the policy must be at least one month old before it will cover preventive services. You must have the policy at least six months before basic services are covered, which will be reimbursed at 50%. Special dental services such as oral surgery, endodontics, and periodontics require that you have the policy in force for 15 months before they will honor claims for these types of services. There is a $50 deductible for both basic and/or special dental services and major dental services. Major dental services require that you have the policy at least 18 months before they will honor any claims. To give you an idea of the cost, for a single individual the monthly premium in New Jersey is $23.60. For a family, it is $64.30 per month. Coverage of this type is also available for senior citizens but the premium is higher. For a single person it is $28.15 per month and for a husband and wife it is $55.30 per month. You can use any dentist of your choice with the Baltimore Life Insurance Company Dental plan. Reimbursement is based on reasonable and customary fees. If you would like more information about this dental insurance policy, please give our office a call.

    Irene Card & Betsy Card Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company . If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, or visit our contact page.

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