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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:

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  • 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 solvency.

  • 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 costly treatment.

  • 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.
  • Dana Dratch is a freelance writer based in Atlanta.

    -- Posted: March 22, 2005




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