Dental and Vision

Dental Coverage

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Most Dental plans have an annual dollar maximum. This is the
maximum dollar amount a dental plan will pay toward the cost of
dental care within a specific benefit period (usually 12 months). The
patient is responsible for covering the costs above the annual
maximum. Many dental plans also have a “waiting period”, which is
the time that must pass before some benefits (e.g., major services)
begin. Waiting periods differ between carriers and plans. Waiting
periods vary from 6 to 12 months, depending on the services
performed.

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Types of Plans

Dental plans are similar in some ways to health insurance plans in
some respects, but different in other ways. You’ll generally have
the following options:

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Preferred Provider Organization (PPO): As with a health
insurance PPO, these plans come with a list of dentists that accept
the plan. You have the option of going out of network, but your
out-of-pocket costs will be higher.

Dental Health Maintenance Organization (DHMO): Like a
health insurance HMO, these plans provide a network of dentists
that accept the plan for a set co-pay, or no fee at all. However, you
may not be able to see an out-of-network dentist.

Discount or referral dental plan: This is a plan in which you get
a discount on dental services from a select group of dentists. Unlike
health insurance, the discount or referral plan doesn’t pay
anything for your care. Rather, the dentists who participate
agree to give you a discount for the care you receive.

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What They Cover

Generally, dental policies cover some portion of the cost
of preventive care, fillings, crowns, root canals, and oral surgery,
such as tooth extractions. They might also cover orthodontics,
periodontics (the structures that support and surround the tooth)
and prosthodontics, such as dentures and bridges. You’re usually
covered for two preventive visits per year.

If you get an individual policy, periodontics and prosthodontics may
not be available in the first year of coverage. And orthodontics
often requires a rider, in which you pay an additional fee, for any
kind of policy.

There’s generally a separate lifetime maximum for orthodontics
costs.

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Vision Coverage

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The term "vision insurance" is commonly used to describe health and wellness plans designed to reduce your costs for routine preventive eye care (eye exams) and prescription eyewear (eyeglasses and contact lenses). Some vision plans also offer discounts on elective vision correction surgery, such as LASIK and PRK.

But unlike major medical insurance policies that may provide unlimited benefits after a certain co-pays and deductibles are met, most vision insurance plans are discount plans or wellness benefit plans that provide specific benefits and discounts for an annual
premium.

In effect, these vision discount and wellness benefits plans offer savings much like a gift card. As such, they can be used to cover much of the cost of basic eyewear, or they can be used to make premium eyewear products and enhancements — such as progressive lenses, anti-reflective coating and photochromic lenses — significantly more affordable.

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Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan.

Typically, a vision benefits package provides free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium or membership fee and a relatively small co-pay (fixed dollar amount) each time you access a service.

A discount vision plan, on the other hand, provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee.

In some cases, a vision benefits package or discount vision plan may also include a "deductible" — a fixed dollar amount you must pay your eye care provider out-of-pocket before the insurance benefits take effect.

Both kinds of vision insurance can be custom-designed to meet the requirements of a wide range of customers, including school districts, unions, and big and small
companies.

Vision plans generally cover or provide discounts on the following products and services:

• Annual eye examinations

• Eyeglass frames

• Eyeglass lenses (including lens coatings and enhancements)

• Contact lenses

• Discounted rates for LASIK and PRK

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