Dental insurance is indispensable since the cost of dental care is exorbitant. A plethora of alternatives are available to people desirous of maintaining good oral health. For a regular premium, the insurance company agrees to cover the cost of dental services. Although, people have the option of choosing either individual or group dental insurance, where the former works out very expensive. Hence, a majority are covered under their employer’s group dental insurance plan. Employers, again, have the option of providing coverage under one of the following dental plans:
- Traditional Dental Insurance
- Direct Reimbursement Plans
- Managed Care Plans
For a long time, employers were providing indemnity or traditional dental insurance. Over time, most employers switched over to managed care plans, viz. Dental Health Maintenance Organization Insurance Plans (DHMO) and Dental Preferred Provider Organization Plans (PPO), since these plans were cost-effective. It would behoove the reader to note that direct reimbursement plans are the most expensive of the lot, although they provide a number of benefits that are not available to people covered under the other two plans. For instance, direct reimbursement dental insurance and no waiting period go hand in hand.
Dental Plans with No Waiting Period
Some dental plans provide coverage for routine care only and a major dental procedure is covered only after the insured individual has bought the coverage plan for certain time period. This period can be anywhere between 3 months to a year. Dental insurance companies invoke a waiting period, as a preventive measure, meant to discourage customers who will sign up for dental insurance, undergo a major dental procedure and then resign from the plan. This brings us to the importance of dental insurance with no waiting period, a couple of plans have been profiled below, for preventive, diagnostic, restorative, major and adjunctive services.
Direct Reimbursement Plans
Direct reimbursement plan is the most expensive dental insurance. No waiting period clause is an inherent feature of this plan on account of the very nature of coverage. The plan requires the insured to pay the dentist up-front for the services rendered. The coverage is typically employment-based and the insured/employee is expected to submit the bill to the employer and claim either a part, or the entire amount of money paid in lieu of the services rendered. In addition to the no waiting period clause, this is the only plan that covers even preexisting conditions. The insured is also allowed to visit any doctor of his/her choice and there is no pre-authorization requirement for any procedure. However, this plan is very expensive and employment based.
Dental Discount Plans
Dental discount plans are preferred to direct reimbursement plans since they are not employment based and are cost-effective, thus allowing the members to save as much as 60 percent on procedures like cleanings, fillings, braces and checkups. Since dental discount plans are not employment based, they are a good alternative to dental insurance for seniors. A person can become a member by paying a nominal membership fee. Being a part of a group confers collective bargaining power on the members, thus allowing them to receive substantial discounts. Hence, these plans are a cheaper alternative to dental insurance. No waiting period clause is also an important feature of dental discount plans that ensures instantaneous coverage for various procedures. Immediate coverage can be attributed to the fact that dental discount plans are different from dental insurance.
Note.: It would always be advisable to read the dental insurance offer document carefully. Conditions do apply and it is mandatory for one to understand the terms and conditions thoroughly. Ensure that you have understood the policy’s waiting period. Negligence in such cases may turn out disastrous for the insurer.
Waiting Period for Dental Insurance Plans
Traditional plans and managed care plans have a waiting period clause. As mentioned earlier, managed care plans are popular group dental insurance plans, since they are the cheapest. While opting for dental insurance, no waiting period clause is one of the most important features that one should focus on, in addition to the preexisting condition excluding period. Although, group plans can help in case of preexisting conditions, people may have to contend with the following waiting period requirement in case of traditional and managed care plans:
Dental insurance plans for individuals does not require a waiting period for preventive procedures, like cleaning. Some companies consider topical fluoride treatment for children, under the age 16 and space maintainers for children under age 12, as preventive oral care, while others term these as basic or restorative. Again, diagnostic procedures like oral exams and radiographic benefits do not have a waiting period. However, restorative services, like fillings, adjunctive services, complex and major services, viz. oral surgery with general anesthesia and emergency treatment, have a predetermined waiting period of 12 months. Missing tooth clause, in the insurance contract, ensures that the insurance company does not pay for dental bridge work before the waiting period elapses. Again, the cost of dentures is not covered by the insurance company for a certain length of time since most companies consider these as major services.
As far as group dental plans are concerned, there is no waiting period for preventive services while there is a short 6-month initial waiting period for basic or restorative services. For major services, the size of the group and the waiting period are inversely proportional. Some insurance companies waive the waiting period requirement even for major services, if the group size is over 10. People, who can afford the premium, can opt for the expensive direct reimbursement plan while others may be better off with dental discount plans.