6 questions to ask a dental insurer
To get a good deal, you need to know exactly what
you're buying. Here are six things to consider:
What's the annual cap on reimbursement?
Most policies, even those you get through an employer, will put
a cap on your annual reimbursement. This can be anywhere from $1,000
to $1,500 a year, says Evelyn Ireland, executive director of the
National Association of Dental Plans.
What's the waiting period for various types
of procedures? "It will vary by company and by product,"
says Dennis McHugh, manager of dental benefit information service
and third-party issues for the American
Dental Association. Typically, companies will require you to
be on the plan a year before major work is covered, he says.
Is the company stable and reliable?
Check with A.M.
Best Company, which analyzes insurance companies on their financial
What percentage will the company reimburse
for various common procedures? And how does the company calculate
reimbursement? Many companies (whether writing for individuals or
large companies) set a price for a particular procedure and the
percentage of reimbursement is based on that, rather than the amount
your dentist actually charges, says Jeff Album, director of public
affairs for Delta Dental of California, New York and Pennsylvania.
It's sometimes called the "usual and customary fee" or
"allowed amount," he says. If that's the case, ask where
the company gets its numbers, how often they are updated and whether
they vary by geography.
Does the company base reimbursement on the
procedure you actually had, or on the least-expensive method to
treat your condition? These are often called "least-expensive
alternative treatment clauses." So instead of getting 50 percent
of what you actually paid, you may get 50 percent of a much less
What's excluded? "When it comes to individual
plans, you also have a lot of exclusions and limitations,"
McHugh says. For example, many plans don't cover orthodontics. Others
will exclude certain pre-existing conditions, such as missing teeth.
But standards are changing. Traditionally, in years past, implants
were not covered, says McHugh. Now some plans are covering them.
is a freelance writer based in Atlanta.