Dental insurance plans: Benefits limitations and deductibles.
What are the financial limitations of the dental insurance plans you are comparing?
An important part of comparing individual dental insurance plans is to evaluate what type of dollar limitations the plans have.
What deductibles are involved with the insurance plan?
You will need to evaluate any deductibles that are associated with the individual dental insurance policy that you are considering. This is the dollar amount you will have to pay out-of-pocket before the insurance company provides any benefits for any dental services. Most indemnity dental insurance plans (traditional dental insurance) will have some sort of deductible, possibly along the line of $50 to $100 per individual but the exact amount certainly can be more or less than this. Dental HMO insurance plans (capitation dental insurance plans) typically don't require the payment of a deductible.
If a deductible is stipulated by the policy you are looking at, here are some questions you should investigate. Is the deductible calculated only on an individual basis or is there some type of cumulative family deductible (which ends up costing the family slightly less)? Will any portion of a deductible paid late in one policy year apply to the next year's deductible? Does the deductible apply to all types of dental treatments or are some services (such as preventive dental procedures) exempted from the need of paying a deductible?
What is the maximum yearly benefit that the dental insurance plan will provide?
You will need to evaluate the plan's maximum dollar benefit. This is typically stated in terms of a yearly maximum. (You must take note of what basis the year time period is calculated. Is it a calendar year or else a year's time frame that starts on the day the plan becomes effective for the member?) For some dental procedures, especially orthodontic treatment, there may be a lifetime dollar limitation also.
Maximum benefits limitations are typically associated with traditional (indemnity) dental insurance plans. This type of limitation often ranges between $750 and $2000 per year but absolutely varies by way of individual plan. Capitation dental insurance plans (dental HMO's) typically don't have a maximum benefit limitation.
Remember, this number represents the maximum dollar amount that the insurance company will pay, not the total value of the dental work received. Some dental procedures, like routine dental examinations and cleanings, may be paid at a very high rate, even 100%. Other treatments, such as dental crowns, bridges or dentures, may be paid for at a significantly lower percentage, say 50%. If this is the case then only a portion of their total cost will be applied to the calculation of the patient's maximum benefit limitation.
You may find that the maximum benefits limitation of the dental insurance plan that you are looking at will put a damper on how much of your dental treatment needs can be completed in any one policy year. If so, don't overlook the possibility of breaking your dental treatment needs into two parts, one of which is initiated late in one benefits year and the other a few days later but in the next benefits year. Doing so can maximize your policy benefits, yet provide a means by which your dental work is still started and brought to completion in just a short time frame.
