Dental insurance plan restrictions: Pre-existing conditions, wait periods, excluded services.
Any individual dental insurance plan will have its own specific restrictions and exclusions. It's important for you to know what they are.
Does the dental plan have a "wait" period?
When you look at the terms and conditions of an individual dental insurance plan you must check to see what its immediate limitations are. Is there a "wait" period during which certain types of procedures will not be covered, or else not covered as fully as they will be after this initial time period has elapsed?
For example, you may find that during the first six months or year of a new dental health plan's term only preventive dental procedures will be covered. More extensive dental treatments, such as placing dental crowns or gum surgery, or even just placing filings, are not. After the initial wait period has elapsed, the plan then becomes more inclusive and covers these services. Depending upon what your immediate needs are, a dental insurance plan that has an extended wait period may be unsuitable for your needs.
Does the dental insurance plan you are evaluating make exceptions for pre-existing conditions?
A dental insurance plan may include provisions in regards to "pre-existing conditions." This term, however, may not mean exactly what you think it does.
The presence of cavities, teeth that are known to need of root canal treatment, or even those teeth with large fillings whose plan has always been to, some day, place dental crowns on them aren't usually considered to be pre-existing conditions. This term is more typically associated with restrictions such as the policy will not pay for dental procedures used to replace a tooth that was extracted before the person was covered by their current dental insurance plan. Or excluding benefits associated with replacing a dental crown, bridge or partial or complete denture that is less than a certain number of years old.
Does the dental insurance policy place restrictions on the types of dental procedures that are covered?
You'll need to know that the dental insurance plan that you are considering provides benefits for the type of dental procedures that you require. With both traditional (indemnity) dental health plans and dental HMO coverage, it is possible that certain types of dental procedures simply are not covered.
You absolutely must check to see what your plan covers. It's not typical, but also not unheard of, that some dental insurance plans will not provide coverage for some procedures as common as dental crown placement. More typically, an insurance policy might not provide coverage for dental implants or extensive full-mouth rehabilitation. In general, it is fairly common that a dental health insurance plan will not cover restorations that are solely placed to repair tooth abrasions, attrition and erosion or restoring or altering the patient's vertical dimension. This stipulation might affect benefits associated with placing some dental crowns, bridges or even some fillings.
Most dental health insurance plans will exclude coverage those dental restorations and procedures that are placed or performed solely for cosmetic reasons are typically not covered by dental insurance plans. These types of dental treatments might include: teeth whitening, porcelain veneers, dental bonding veneers and possibly even some applications of dental crowns, dental bridges or white fillings.
