What is dental insurance?
Dental insurance is an agreement with an insurance company that helps to cover the cost of treatments for your teeth and gums. Instead of paying the entire cost out-of-pocket, dental insurance pays a percentage and you pay the remainder.
People receive dental insurance through their employer, but you can also purchase an individual or family dental insurance policy directly from dental insurance companies. You can buy an individual or family dental insurance policy directly from dental insurance companies.
How does dental insurance work?
Dental insurance works by sharing the costs of dental care in exchange for a premium you pay. You may also have to pay deductibles, copays, and other costs, but the details vary from plan to plan. Dental insurance is available as part of medical insurance plans or as a standalone policy purchased from the Marketplace or a dental insurer.
What Is group dental insurance?
Many employees consider group dental insurance a crucial part of their benefits package. As one of the most utilized group benefits, dental insurance can be a valuable investment in attracting and retaining top talent.
Access to dental insurance helps employees manage out-of-pocket costs and encourages regular dentist visits to prevent future dental issues. Visit the dentist regularly. That routine, preventive care helps employees avoid dental issues down the road.
How does group dental insurance work?
Dental insurance typically classifies dental care into three main categories: preventive, basic, and major. The category of service determines the percentage of the cost that the insurance covers. For instance, insurance may cover 80% of the cost of a service considered basic care, with the patient responsible for paying the remaining 20%.
Under Principal dental insurance, routine exams and cleanings are considered preventive care and are fully covered, meaning you will not have to pay anything for those services. Fillings are labeled as basic services, while bridges fall under major care. The insurance covers a percentage of the cost of basic and major care, and the patient is responsible for the remaining cost.
What does group dental typically cover?
Group dental insurance usually covers preventive care at no cost, such as two annual teeth cleanings and x-rays. There are three different classes of coverage with varying benefits and cost structures. The annual maximum benefit applies to all three tiers, and most dental plans have a 100/80/50 coverage structure, although not all.
- Class 1 dental insurance provides preventative and diagnostic care such as cleanings and x-rays. Services in this class are covered at 100%, up to two visits.
- Class 2 dental insurance provides basic restorative care, including fillings and some repairs to crowns and bridges. Services in this class are covered at 80% beginning after your deductible is met.
- Class 3 dental insurance provides coverage for major restorative procedures, such as implants, crowns, and root canals. Services in this class are covered at 50% after your deductible is met and the waiting period is past.
What does group dental typically not cover?
Group dental coverage does not cover treatments for cosmetic purposes, such as correcting congenital mouth formations like a cleft palate unless it is deemed medically necessary. Some plans may include coverage for orthodontic procedures, but not all do. It’s important to understand that services not covered by Medicare Part B will also not be covered by an individual dental insurance policy.
Can group dental be used with any dentist?
The network of eligible dentists and coverage depends on whether the plan is an HMO or PPO. Both options typically include 100% coverage for preventative care.
- Health Maintenance Organization (HMO): You will need a primary dentist for an HMO. These are generally a smaller network of doctors and have a flat fee for non-preventative care.
- Preferred Provider Organization (PPO): You can generally visit any dentist you choose. PPOs have a broad network of doctors, and individuals need to meet the deductible for non-preventive care. A more extensive network of doctors and individuals must meet the deductible for non-preventative care.
