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Take a look -- or bite -- at this insurance

Signing on for the medical insurance that an employer might offer is usually pretty much a no-brainer. But many companies also offer dental insurance and vision insurance, and the choices there aren't quite so obvious.

For one thing, employees frequently have to pay for it. Also, the coverage is often quite limited. So, is it worth it?

Do you have good teeth? Bad teeth? No teeth? No matter what state your mouth is in, you should seriously consider dental insurance.

For those of you with excellent choppers, the preventive care feature of a dental plan pays 100 percent of your routine dental visits to keep those pearly whites sparkling. But even if you haven't seen a dentist since your canines were pups, routine restorative care or major restorative care features can help cover the cost of getting you a healthy smile again.

If your employer offers a dental plan, it will probably have categories of coverage for preventive care, routine restorative care and major restorative care. If you are really lucky, you might get to choose between two dental plans or more. If that's the case, here are some guidelines to help you compare them.

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According to Thomas D. Musco, director of research and statistics for Health Insurance Association of America, you should consider the following when deciding which dental plan best meets your needs:

  • Compare deductibles
    There should not be a deductible for preventive care. It should be covered at 100 percent. However, dental plans usually have deductibles of $25 or $50 for routine restorative or major restorative care. The lower the deductible, the better for your wallet.

  • Compare the maximum annual benefits
    Once you've paid your deductible, dental coverage kicks in. But there are limits to what the insurance company will pay. If you know you have some major mouth work to be done, you need to pay special attention to your plan's maximum annual benefit. Usually these maximums run between $1,000 and $1,500.

    "Work with your dentist to schedule procedures to use benefits most efficiently and use the preventive care benefit to avoid major problems in the future," said Musco.

    Depending on what you need done and what it will cost, you may want to have the work done over the span of a couple of years to maximize the amount that the insurance company will cover for you. Get the most immediate dental needs taken care of in the first year, and then have additional work done in subsequent years.

  • Does the plan offer an orthodontia benefit?
    Compare lifetime maximums. This is especially important for families with young children. If your little princess needs braces, you want help in covering the cost. Compare the lifetime maximums to determine which plan offers you the most. Generally, a $1,500 lifetime maximum is standard.

  • Compare the categories of coverage and the percentages covered.
    Preventative care, such as your annual checkup and annual X-rays, are almost always covered at 100 percent. Normal or routine care, such as fillings, root canals and periodontal care, are usually covered at 80 percent. Major restorative care, which includes fun things like bridgework and crowns, is generally covered at 50 percent.

  • Ask about new features
    "Dental plans haven't changed much over time," said Musco, "but there are some new features to look for. Ask questions about implant procedures. These are relatively new in the last 10 years or so and some plans will cover them at major restorative care levels."

  • Consider the overall plan cost
    So what should the average consumer expect to pay for dental coverage?

    "The William M. Mercer National Survey of Employer-Sponsored Health Plans 2000 cites a cost of about $470 per employee. This is an average of single and family costs together, but some of the cost may be covered by an employer," explains Musco.

    "Compare this cost with the $4,600 average cost of health insurance and you see how affordable it is. Especially on the group side, if an employer picks up part of the cost it's probably a real bargain," says Musco.

    However, what if your employer isn't paying a dime and it's all out of your pocket? Is it still worth it then?

    "There have been several studies that link oral health with medical health -- heart disease as a result of poor dentition, for example -- and employees should definitely consider dental coverage. It's worth it, " Mucso says.

    If you have dental problems that need to be fixed, paying for dental insurance should save you money in the long run. And if you have excellent dental health, the preventive benefits of dental insurance will help make sure it stays that way.

    If you're looking for dental coverage on your own, check with the company or agent providing your medical coverage. If that company doesn't offer it, check the Internet for providers in your area. You may be able to save some money by getting a multi-line discount.

What about vision coverage?
Vision coverage is a little different. Typically, an employer will offer vision coverage as a discount program.

"Usually an employer negotiates with local ophthalmologists or vision centers to obtain discounts in services for referring their employees," said Musco.

Costs for vision coverage will vary by employer but should provide you with at least a 10- percent discount.

What does it cover?
Vision coverage is meant to cover only predictable costs, such as comprehensive annual or biannual exams, lenses, frames and contact lenses. The American Optometric Association recommends the following for a comprehensive eye exam:

  • A check of internal and external eye health for signs of possible disorders, such as cataracts or problems with your retina
  • An evaluation of your current prescription (glasses or contact lenses)
  • A visual acuity test to check your ability to see clearly at all distances
  • A refraction test to determine your eyes' ability to focus light rays on the retina at all distances
  • A glaucoma test of your eyes' internal pressure
  • A visual coordination test for muscle control
  • A test of your eyes' ability to change focus

While an eye exam may reveal eye problems, the purpose of vision coverage is not to replace your medical coverage.

"Most likely if a tumor or cyst is discovered during a routine exam, treatment for it would then be covered under the individual's medical plan," said Musco.

You can compare vision plans by checking to see whether exams are covered each year or only once every other year. Another way to compare vision coverage is to check how often lenses, frames or contacts are covered and in what amount.

Who needs it?
You do, if you wear contacts or glasses, or have family members that do. Getting a discount on services and corrective lenses you need anyway is an obvious plus.

It is not often considered as an individual benefit, but if you're looking for a plan on your own, shop around a bit. Check with professional groups or organizations you belong to to see if they offer it as an association benefit, at association rates. You may be able to save yourself some money. And that benefit is clear, no matter what your prescription.

Heidi St. Jean is a freelance writer based in Connecticut.

-- Posted: Sept. 23, 2003

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