Getting to know the basics of Dental and Vision insurance:

We all know how important it is to stay healthy, and that includes taking care of our dental and vision health with routine check-ups and examinations. Dental and vision treatment costs can be expensive, and depending on your needs these two types of insurance can save you a lot of money in the long run by offsetting some of its associated costs.

If you’re thinking about adding dental or vision benefits to your individual health insurance plan, or receiving coverage through your employer-provided insurance, it’s a good idea to equip yourself with some essential knowledge on these types of insurance. 

Knowing about the types of dental and vision insurance plans

Dental and vision insurance plans are usually not offered as standalone plans, but instead as an add-on benefit. This add-on benefit, often referred to by insurers as a ‘rider’, is linked to health insurance plans and charges its own additional premium – the additional premium charged will vary depending on the plan and the provider.

If you’re looking for mainly dental or vision benefits, some providers out there do offer plans consisting of mostly dental or vision coverage. It’s important to note that not all plans are the same, and that dental and vision insurance plans tend to come in two types.

Types of dental insurance

There are two main levels of dental insurance: routine dental treatment and major dental treatment. Please note that most plans won’t cover cosmetic procedures such as teeth whitening, although with some plans you may be able to get a discount on certain cosmetic treatments.

Routine dental treatment usually comes with a lower premium than major dental treatment as it covers more common forms of dental treatment, including consultations, teeth cleaning, check-ups, emergency treatment, x-rays, and root canal treatment.

Major dental treatment coverage tends to charge a higher premium, but coverage limits for this type of dental insurance will usually be higher too. This level offers coverage for more expensive dental work, and combines treatment covered by routine dental treatment with major dental work such as orthodontic work deemed medically necessary (e.g. braces), root scaling, gingivitis treatment, periodontists treatment, dentures, and root scaling.

Types of vision insurance

The two main categories of vision insurance include the vision benefits package and the discount vision plan.

The vision benefits package typically provides coverage for comprehensive eye examinations, frames and contact lenses. With this type of plan, you will usually need to pay a certain amount (co-payment) for every ophthalmic service, as specified before signing up on the plan.

The vision discount plan is often attached with a much lower premium and also provides coverage for eye exams, frames and contact lenses. Instead of paying out on the claims you’ve submitted, this type of vision insurance gives you a percentage discount for every ophthalmic service.

LASIK surgery and PRK vision correction are not usually covered by vision insurance but are sometimes offered at discounted rates.

Preferred network of providers

Another thing to be aware of when looking at dental and vision plans is to see if they have a preferred network of providers, which is a list of health care providers that have been contracted with an insurance plan so that the insurers can negotiate better rates.

If you’ve got a dentist or ophthalmologist that you visit regularly, it’s a good idea to check if they’re in your potential plan’s in-network. It’s also worth checking if the providers covered in the plan are located in a reasonable distance from where you live.

Depending on the provider and the plan in question, submitting any claims for out-of-network treatment may end up in your claim being rejected, while some insurers will pay out only a certain percentage of the bill.

Waiting periods

Many dental and vision plans will have a waiting period, also commonly referred to as a probationary period. This means that there will a specific amount of time (ranging anywhere from 1 to 24 months) from when you have first secured your plan where you will have little to no benefits.

It is very common to see add-on benefits attached with waiting periods, as this protects the insurance company from the risk of a high payout by preventing people from purchasing these types of insurance only when they require an expensive procedure, e.g. extensive orthodontic work.

Shopping around for plans on your own can be hard, especially when there are so many things to be consider. This is why it often pays to have a chat with an experienced insurance broker for additional peace of mind.

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Arnold Smith

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