Dental & Vision

Proper dental care can be an important component of our well being. As with all insurance-related decisions, there are multiple facets that should go into your decision when purchasing coverage for yourself, family, business, or your employees. And, there many types of plans to consider such as a PPO (Preferred Provider Organizations), HMO (Health Maintenance Organization), dental indemnity insurance plans, and discount dental plans.

Why It’s Important

Dental coverage of some kind can help you ensure the health of your teeth and gums. Unfortunately, if you are bearing the full brunt of the cost of dental care you may find it difficult to pay your dentist bills. Without dental insurance coverage, you may be tempted to skip regular cleanings and checkups, a decision that could lead to serious dental health problems.

Types Of Dental Insurance Coverage

Similar to medical insurance plans, dental insurance policies are often categorized as either indemnity or managed-care plans. The major differences are concentrated around out-of-pocket costs, choice of dental care providers, and how bills are paid.

Typically, indemnity coverage offers a broader selection of dental care providers than managed-care policies. With an indemnity policy, the carrier pays for covered services only after it receives a bill, which means that you may have to pay up front and then obtain reimbursement from your insurance carrier. Usually, managed-care policies maintain their own dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you.

Basic Dental Insurance Coverage – What Is Included?

Understanding what is covered by your dental insurance can be challenging. Coverage differs from policy to policy and from provider to provider. Read the fine print of your policy or agreement to find out what your dental insurance covers. In general, basic dental insurance coverage includes three categories:

  1. Preventive and diagnostic dental care: Almost all dental plans and dental insurance policies cover basic dental costs that are meant to prevent dental problems. For the policyholder that means, most plans covers a large part or all the dental costs associated with basic services such as cleaning, checkups, and other dental procedures meant to prevent tooth and gum disease. This coverage is important because it encourages people to seek regular dental care, which can prevent more complicated and costly problems.
  2. Basic dental care and dental procedures: Most dental plans and dental insurance also cover basic dental procedures such as fillings, tooth extractions, fixing chipped teeth, and other such basic procedures. However, basic dental care varies from one provider to another. In general, since providers cover a significant portion of basic dental care, it makes sense to select a dental care insurance provider that covers as many dental care basics and procedures as possible.
  3. Major dental care: While not all dental insurance plans cover major dental care, some do cover at least a portion of these costs. Major dental care can include procedures such as dental surgery, orthodontics, denture work, and other large, expensive dental procedures. If you will require major dental care at some point in the future you may wish to look for a provider willing to pay for as large a percentage of this type of care as possible.

This is a brief overview of the coverage that can be included in a Dental Insurance policy. You should read a policy thoroughly before purchasing any insurance policy.

It’s no surprise that vision insurance is misunderstood by many people. Depending on the reason for the doctor visit – a routine exam or an eye injury – it’s not always clear which doctor to visit.

At its most basic level, vision insurance helps cover the cost of routine eye exams, contact lenses and glasses. Some vision plans also pay for corrective procedures such as laser eye surgery. Additionally, most plans include one pair of glasses or contacts a year.

Which policy covers an eye injury or disease?

Routine vision exams to an optometrists or general ophthalmologists may produce final diagnoses such as nearsightedness, farsightedness or astigmatism. During this exam, the optometrist or general ophthalmologist might detect a problem related to diabetes or some other disease. A medical eye exams may produce a diagnosis such as conjunctivitis (pink eye), a common occurrence among children. Most insurance companies focus on the reason for your visit, so your health insurance probably would not cover a routine eye exam but, a follow up visit to your doctor because of a problem detected during a routine eye exam might very well be covered. Plus, your health insurance probably would cover a doctor visit for an eye disease or eye injury.

What Does Vision Care Insurance Cover?

Vision care insurance usually covers a percentage of the following basic services:

  • Yearly eye examination
  • Eyeglass lenses
  • Eyeglass frames
  • Contact lenses
  • LASIK and PRK vision correction procedures at a discounted rate

Your specific vision care plan may have a limit, such as annually or every two years on how often it will pay for lenses and frames.

Who Provides Vision Care Services?

Frequently, vision care plans (including those you buy or are provided by your employer) contract with eye care professionals. In some plans, you use a certain eye care provider and receive a discount on the services offered. However, most plans purchased from a vision care insurance company are PPOs (preferred provider organizations) where your eye care is managed by a network of eye care providers. In a PPO, you also can use out-of-network eye providers, but you must pay a greater share of the cost.

Typically, eye care offices and networks include optometrists and general ophthalmologists. Some networks also may include ophthalmologists who perform refractive surgery, and provide LASIK or other vision correction procedures.

Do I Need Vision Care Insurance?

If you or members of your family wear corrective lenses and need periodic eye exams and changes in your eye lens prescription, it may be worthwhile to purchase vision care insurance. If you do not currently wear or need glasses, you may be able to get a periodic eye exam through your regular health insurance plan.