How does dental insurance work?


Dental insurance works very much like health insurance. You buy a plan that provides a list of the benefits you get to receive during the life (effectiveness) of the plan and you get to make a claim on these. For a basic dental insurance this would include:

  • Routine check-ups
  • Cleanings
  • Fillings
  • Dental x-rays
  • Root canals
  • Crowns
  • Fluoride treatments and sealants (particularly for children)

If you have a more comprehensive (and more expensive plan), you can avail of more services which can include dental implants or oral surgery. Dental plans that offer orthodontics (braces) are available, although most plans will not cover anything that is elective or cosmetic. Aside from orthodontics, this would be veneers and teeth whitening.

There are some dental plans that have a waiting period. That means that if the insurance company will not cover any treatments done within a specified period after the policy has been issued. This is a way of insurance companies to protect themselves from individuals who buy a dental plan because he already knows that he needs immediate treatment.

Some dental plans will specify a per benefit limit, as well as an annual limit.

  • The per benefit limit is the amount the insurance company will pay for each instance a covered treatment is availed.
  • On the other hand, the annual limit is the maximum amount that the insurer will pay for the year.

Some dental plans have a deductible, which is essentially your share of the treatment. When your plan involves a deductible, the insurance company will pay for the amount over and above the specified deductible, subject to the maximum limit for a given dental treatment.

The way you will avail of the dental treatments depend on what kind of plan you have.

There are dental insurance plans that are purely reimbursement, meaning you pay for the procedures and then file a claim. The insurance company will check that treatment against their benefits schedule and they will pay up to a maximum of what is stipulated in that schedule, less a deductible, if there is any.

There are also HMO dental plans that let you avail of the treatments without shelling out any money. What happens is that you go to an HMO-accredited dentist and have your treatments there. The dentist will be the one that will collect the fees from the insurance company.

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