Friday, May 27, 2011

Dental plan coverage?

Just a quick general knowledge question. Someone at work here is questioning our dental plan becuase she needs a root canal. I personally rarely use the health or dental coverage. I was under the impression that most dental plans paid a percentage of the cost of dental work up to a predetermined out of pocket amount for the insured. For example, the insured may have to pay 60% of the cost of dental work during the year up to a total out of pocket expense of $2,500, after that , all is covered. Someone else at work is saying it is the opposite. The insurance co. will pay their percentage up to a predetermined amount and then it's all on the insured. How are most policies structured?
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O.k.,this is how dental insurances work.Usually they separate the services on:Preventative care(usually covered at 100% with no deductible);Basic care(usually covered at 80%) and Major care(usually covered at 50 or 60%).If you need any services that fall under the Basic and Major category then you will usually pay yearly deductible and on top of that the percentage that it is not paid by your insurance.There is a certain amount the insurance will pay per year,for example from $1000 to $2000 or more.Once they pay all that it means that you have reached your yearly maximum and if you decide to have any more dental work done after that ,the cost will be out of your pocket,but if wait for your new benefit year ,then you will have another 1000 or 2000 dollars available. This information is general,because I have seen insurances with no deductible,who cover everything 100% or some who have unlimited coverage.Very important is also to make sure that the dentist you are going to visit is in the network with your insurance,cause if he is not,you might not be covered or might have to pay more out of pocket!Well,I hope I was helpful,I deal with dental insurances all day at work,so you can trust me!:))
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