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Your Dental Insurance Shopping Guide

Aug 17, 2007
Dental care is an important part of a healthy lifestyle - but because dental coverage is not a part of standard health care insurance, it's something that can often get forgotten until it's too late. The rising cost of good dental care means that insurance might be just what you need to ensure your teeth remain healthy and well cared-for throughout your life.

When you're shopping for a dental plan there are a number of things you'll need to keep in mind, to make sure that you end up with a policy that's right for you and your situation.

What services are covered?

Not all dental plans are created equal - each plan is different, and may provide coverage for different services. A typical dental insurance policy might include any or all of the following:

- Routine check-ups
- Bridgework, crowns, fillings, dentures
- Straightening crooked teeth
- Root canals, removal of wisdom teeth, or other surgery
- Treatment of tooth, gum, and mouth infections
- Treatment of oral cancer

Most dental insurance companies categorize these services into three groups - preventative, basic, and major services. Make sure the policy you choose covers all three types, as many do not cover major procedures.

How much choice do you have when it comes to selecting a dentist?

Many dental insurance companies negotiate special fee schedules with selected dentists. In exchange, these dentists become preferred providers for the insurance company. Some policies will require that you use only dentists on the preferred list. Others may allow you more choice in selecting a dentist, but you may be required to pay a certain amount of money for services obtained from a non-preferred dentist.

When you're shopping for a dental insurance plan, ask each company for a list of dentists in your area that are on the preferred list, so that you can decide on a suitable dentist before committing to a plan.

What is the yearly maximum that you can claim?

The yearly maximum is the maximum amount of money you can claim within a year. The typical yearly maximum is one thousand dollars. This renews each year, but any unused money is not carried over to subsequent years.

The usual customary and reasonable fee guide

This guide is a fee schedule which details the maximum amount of money an insurance company is willing to pay for the dental procedures they cover. This is often lower than the amount that a dentist actually charges, and you will usually be required to pay the difference yourself if you choose a non-preferred dentist.

Other questions to ask

- Is there a minimum amount of time you must pay premiums before coverage actually begins? For many policies, there is a waiting period between signing an insurance contract and being covered for certain procedures.
- What does the insurance company consider "basic services"? This may vary between each company, and some companies have a waiting for major services only.
- Does the company have a "missing tooth clause" or a "replacement clause"? More than 90% of dental insurance policies contain one or both of these clauses. The missing tooth clause means that if you lost a tooth prior to getting insurance, the policy does not cover the cost of replacing that tooth. The replacement clause is similar to a waiting period, in that the company will not pay for replacement bridges or dentures until a specified period of time has elapsed.
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