Dental insurance

Dental insurance

Make sure that you don’t take any risk for the cost of dental treatment. Opt for an Envivas insurance plan for your teeth! In addition to the Envivas dental insurance plans for denture benefits there is plan «Pro» that covers costs for dental prevention and fillings.

Dental Insurance Plans

Fill out your health coverage

Dental insurance is designed to offer you coverage for common dental care issues and to help you budget for dental services at all levels, preventive, basic and major.

UnitedHealthcare has dental insurance plans, underwritten by Golden Rule Insurance Company, that are just right for helping you fill out your health care coverage.

Flexible and convenient

From our plans, you can choose the best dental insurance for your needs featuring:

  • Preventive care like routine cleanings and fluoride treatments covered with NO deductible or waiting period
  • Coverage for basic services like fillings or emergency treatment for dental pain and major services like retainers and root canals, which are subject to the plan’s deductible and waiting periods
  • Access to an extensive dental network of more than 182,000 dentists1
  • No need to submit claim forms. We pay in-network dentists directly

And with no age restrictions, our plans offer coverage for every member of your family and every stage of life. That includes if you are on Medicare, which doesn’t include dental benefits.

Worried about affordable dental insurance

The cost of not taking care of your oral health could be more. Those without individual dental coverage are less likely to get routine dental care, meaning they seek out a dentist only when they have a problem. By then, more extensive and more expensive measures may be necessary, and major problems linked to poor oral health (like heart disease and diabetes) are more likely to appear.2 Doing nothing now means you might pay more later.

We have multiple plans with different levels of benefits to help you find the best dental insurance fit for your budget.3 So if you’ve ever bought a gym membership or a treadmill to help remind you to take care of yourself, supplemental dental insurance from UnitedHealthcare can be that reminder to take care of your teeth. Even better, it can help you plan, control and budget for the costs of your dental care.

Going to the Dentist in Germany

There is no need to be concerned about the quality of dental care, or any other kind of health care, in Germany. It’s comparable in just about every way with the care you get in the USA, and there are some who think it’s better. (This is especially true regarding implant treatment.) The Germans are very thorough, and do lots of testing. Treatment is done following very strict regulations.

There is no shortage of dentists in Germany, not even in rural areas. Since 1993 the state-run insurers have been barred from accrediting more dentists than have been statistically determined to be needed in their areas. There is no requirement that a dentist have this accreditation. But if he or she doesn’t have it they can accept no state-plan patients and private patients are hard to come by in these days of a dentist surplus.

All this has led to some downward pressure on the prices they charge. Prices tend to vary. So, it’s good idea to compare prices — especially if you don’t have adequate insurance coverage. With a simple price comparison you may be able to save up to 60% on treatment costs.

There may be some language problems but, as with educated Germans in general, many dentists speak some English and it shouldn’t be hard to find one who can work with you. Dental emergency services are available throughout the country. You’ll find a list of the numbers to call at dentists’ offices, pharmacies, hospitals, police and fire stations and in the daily newspapers. Dental work can be covered by health insurance, but things may get a bit complicated here so it pays to investigate. There are two basic kinds of health insurance in Germany, and both have provisions for covering some, but seldom all, of the costs of dental care. There are state-run plans and private plans.

Insured persons, whether under the state-run or private plans, are covered for routine procedures such as simple fillings and dental hygiene. But major dental work, such as crowns and dentures, is only partially covered by the state plans. Privately insured persons may fare better with major dental work. But they should investigate carefully the type of dental coverage they have purchased. German companies usually limit the coverage new policyholders can receive. They probably will require a waiting period of eight months before they will make any reimbursements at all, and after that may restrict their reimbursements to 60% to 80% of the total cost of major dental work.

Payments to dentists under the state-run plans are being cut in other areas too as part of a big government program to trim expenditures. This could well mean that if you have state-run insurance you could be left holding the bag for more of your dentist bill than before. It’s a good idea to check with your state-run insurer and find out what sort of dental coverage it provides. You might want to purchase some inexpensive supplemental coverage from a private insurer.

Anyone faced with major dental work should get a detailed cost estimate (Heil- und Kostenplan) before any work is begun and submit it to their insurer for prior approval. You can usually request this estimate to be done in English.

Ask for a «medical risk form», «medical history form» and the «new patient form» to make sure that your dentists knows about any health problems, medication you may be taking and allergies.

Dental Health Insurance

Dental health insurance plans vary widely. You should know how your plan is designed, since this can significantly affect the plan’s coverage and out-of-pocket expenses.

  • Direct Reimbursement programs reimburse patients a predetermined percentage of the total dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed, allows patients to go to the dentist of their choice, and provides incentive for the patient to work with the dentist toward healthy and economically sound solutions.
  • «Usual, Customary, and Reasonable» (UCR) programs usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist’s fee or the plan administrator’s «reasonable» or «customary» fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called «customary,» they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the «customary» fee level.
  • Table or Schedule of Allowance programs determine a list of covered services with an assigned dollar amount. That dollar amount represents just how much the plan will pay for those services that are covered, regardless of the fee charged by the dentist. The difference between the allowed charge and the dentist’s fee is billed to the patient.
  • Capitation programs pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge (for some treatments there may be a patient co-payment). The capitation premium that is paid may differ greatly from the amount the plan provides for the patient’s actual dental care.

Understanding Dental Insurance Plans

Predetermination of Costs

Some dental insurance plans encourage you or your dentist to submit a treatment proposal to the plan administrator before receiving treatment. After review, the plan administrator may determine: the patient’s eligibility; the eligibility period; services covered; the patient’s required co-payment; and the maximum limitation. Some plans require predetermination for treatment exceeding a specified dollar amount. This process is also known as preauthorization, precertification, pretreatment review, or prior authorization.

But is having dental insurance important, too?

When you’re budget is tight and you lack dental coverage, it’s all too easy to put the health of your teeth on the back burner. Then again, one missed dental checkup can turn into years without seeing a dental professional. This puts teeth at risk when they aren’t given the proper preventative care they need.

Although the Affordable Care Act now requires that individuals and small group market plans cover pediatric oral care services, it does not require coverage of oral health for adults. In fact, the National Association of Dental Plans reported that more than 40% of Americans lacked dental coverage in 2012. Those who lack proper coverage are far less likely to visit a dentist for acute pain or other dental issues, let alone for regular checkups and examinations at the dentist’s office.

Still, many Americans wait until something is wrong before they see the dentist. For those without dental care, about 56% of people said that they delay or skip preventative treatment because of the high costs, according to the 2013 U.S. Survey of Dental Care Affordability and Accessibility. However, many Americans don’t realize how often a treatable dental issue can quickly add up in damage to teeth and finances.

The Cost of Skipping Dental Care

“The cheapest cavity is the one you never get,” Cleveland dentist Matt Messina tells U.S. News & World Report. If money is the thing keeping you from visiting from the dentist, it’s time to reevaluate the cost of not keeping up with regular professional dental care appointments and treatments. Of course, keeping up with regular brushing and flossing is crucial for preventing cavities and taking care of your gums.

According the American Dental Association (ADA), an analysis of the most recent federal data shows that dental ER visits doubled from 1.1 million in 2001 to 2.2 million in 2012. Along with dentists across the nation, the ADA officials say that the problem is worsening despite health reform.

Even if patients can’t pay, emergency rooms are required by law to treat patients. What many American don’t realize, however, is that many ERs are unable to do more than provide painkillers and antibiotics to dental patients. Plus, the cost of the visit itself is often 3 times more than a routine dental visit that could’ve prevented the issue in the first place. According to USA Today, the average dental emergency room visit costs about $749, and that’s if the patient isn’t hospitalized. Overall, this ends up costing the U.S. healthcare system $1.6 billion a year.

But things aren’t much easier for those who do have traditional dental insurance. Most plans only cover up to $1,000 per year, which is a maximum that hasn’t increased in decades. Although that amount could have covered a major dental issue in the 1970s, it may not even cover a full procedure like a single crown nowadays.

Risks of Skipping Dental Care

On top of preventing costly procedures, it’s important to seek proper dental care for the sake of your oral health. Here are some risks that can occur as a result of dental neglect:

  • Losing teeth
    Skipping a visit to the dentist can easily lead to the loss of a tooth in the long run. Getting regular check-ups will allow the dentist to catch teeth problems it the early stages, and prevent potential loss.

  • Gum disease
    Neglecting to provide proper care for your teeth and gums can lead to gum disease. Even though the symptoms aren’t always noticeable at first, it can lead to painful inflammation and loss of teeth. Getting to the dentist for regular cleaning can help prevent this disease.

  • Stained teeth
    Regular dental cleanings help remove debris and stains to keep your teeth healthy. Regularly smoking, chewing tobacco, and drinking staining beverages like red wine or coffee causes tooth discoloration. If you want to keep your teeth feeling and looking their best, you need to keep up with dental appointments.

  • Infection
    What seems like a minor toothache can sometimes advance to a serious infection. For example, when the bacteria in your mouth builds up between teeth and gums, it can lead to a tooth abscess. Most people seek treatment right away because of the pain. But if left untreated, the infection can spread to the surrounding bone and tissue.

6 Alternatives to traditional Dental Insurance

If you work for yourself, are unemployed, or simply lack access to dental insurance, getting dental coverage can be tricky and expensive. Thankfully, there are other options that are can make dental care more affordable and accessible to everyone.

  1. Look into charitable dental clinics or events.
    Find out if your local community has low-cost or free dental clinics. Often, they are run by volunteers from local dental practices. Look for opportunities in your area offered through America’s Dentists Care Foundation or Dentistry from the Heart.  Both organizations also host dental care events where hundred of dentists and assistants volunteer for 2-3 day long events, helping thousands of people each year get the dental care they need.

  2. Ask for a discount.
    It doesn’t hurt to ask for a discount. Depending on the dental provider, some practices offer 10% off the cost of a visit or procedure if you pay upfront or in cash. By asking politely, you may just save yourself some money and take care of your teeth in the process.

  3. Keep up preventative maintenance.
    There really isn’t a better way to save on dental care than to take great care of your mouth and teach your children proper preventative dental care. Brushing at least twice a day, flossing regularly, and rinsing your mouth can keep your teeth protected from tooth decay and other issues. On top of making sure that you are brushing correctly, you can also avoid foods that damage your teeth. Acidic and sugary beverages like fruit juice or soda can seriously damage tooth enamel.

  4. Get just 1 cleaning per year.
    If you can’t afford to keep up with regular cleanings and examinations every 6 months, cutting back to 1 visit per year should be fine. Studies have shown that for most patients, 1 visit per year is enough to ensure oral health maintenance. So unless you’re at a high risk for gum disease or other dental issues, you can save a little money and time with an annual visit to the dentist.

  5. Consider visiting dental schools.
    You can get access to cheap dental care by visiting a dental school for treatments. Dental students need practice and work under the supervision of instructors to provide affordable and safe dental care. Many schools offer huge discounts on a variety of procedures. Just be sure to check that the dental school is accredited with the ADA.

  6. Get a discount dental plan.
    A discount dental plan is a membership that allows you to save 15­–50% per visit and procedure. All you pay is a low monthly fee, less than $15 per month, to get cheap dental care. Once you’ve joined a plan, you’ll receive a card that you and your entire family can use to get the care they need. Other perks include discounts on whitening treatments, which is typically not covered by traditional insurance. Plus, there are no annual limits, and there is a large network of dentists to choose from who accept dental cards. You can find more about Carefree Dental’s discount plan here.

Any of the options above may be a good choice for you, but the most important thing is to make sure that you get the dental care you need. Whether or not you have insurance, it’s important to take good care of your teeth for the sake of your health and finances.

INDIVIDUAL DENTAL INSURANCE

Keep calm and smile on with dental insurance from PDCM. We are committed to provide affordable dental insurance to individuals and family. Explore the opportunities and benefits of dental insurance for individuals.

PLAN OPTIONS:

  • Indemnity Plans — allow you to pick your own dentist and are considered a fee-for-service plan.  They come with limitations and co-payment stipulations, meaning that you pay a flat fee for your visit to the dentist and have an annual limit on dental spending coverage. There may also be specific limits for individual procedures.
  • Self-Insurance Plans — are similar to indemnity plans, but you may not be able to pick your own dentist.
  • Closed Panel Plans — limit you to only a few facilities and dentists to receive care.
  • Capitation Plans — designate certain dentists for a schedule of treatments. Dentists will receive payment regardless of whether the treatment was required.
  • Preferred Provider Organizations (PPO) — limit you to only a few dentists who can provide care at a discounted cost.
  • Dental Care Service Plans — are groups of dentists who create a nonprofit organization, providing care at set fees.

Waiting Period
Usually individual plans involve a waiting period. The waiting perod means you will not have coverage for certain services (typically Class III procedures) for the amount of time specified in the plan. This prevents soemone from purchasing insurance for temporary use for a major dental surgery, then dropping the coverage when the policy expires.

Choose the NEW and enhanced Health & Dental Insurance for CREA Members
Now with more coverage options and benefits!If you have no group coverage at work, you know how medical costs can quickly add up — especially those not covered by your provincial health plan.

With health care costs rising steadily, you are left to your own means when it comes to protecting yourself and your family. Without supplementary health coverage, you would have to pay out of your own pocket for common expenses like prescription drugs, dental care, vision care, therapeutic services and more.

The new Health & Dental Insurance for CREA Members has been enhanced to offer you great value and benefits!

More choices. Cover yourself, your spouse and your children with your choice of eight different levels of health and/or dental coverage. You’ll save by paying for only the coverage your family needs.

All plans include Extended Health Care. You don’t have to pay extra for benefits like vision care, registered specialists and therapists, ambulance services and more.

Tax savings. If you’re self-employed, premiums may be a deductible expense for your business. Check with the Canada Revenue Agency for more information.

Flexibility and convenience. NO waiting period or deductibles. Fast claims submission.

Now included at no extra cost:

  • Health Service Navigator® – You and your eligible family members can quickly and easily get answers to your questions and access to support services. Read more
  • Travel Coverage – covers emergency medical expenses while travelling outside your province of residence
  • Survivor Benefit – continuous coverage for one year following the death of an adult insured
  • Lifeline® Personal Response Service – a monitoring service for people with medical problems at home

Policy Regarding Dental Insurance

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. You must be familiar with your insurance benefits, as we will collect from you the estimated amount insurance is not expected to pay. By law your insurance company is required to pay each claim within 30 days of receipt. We file all insurance electronically so your insurance company will receive each claim within days of the treatment. You are responsible for any balance on your account after 30 days, whether insurance has paid or not. We will be glad to send a refund to you once insurance has paid us.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. We do not have a contract with your insurance company, only you do. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment, we at no time guarantee what your insurance will or will not do with each claim. We also can not be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you.

Fact 1 — NO INSURANCE PAYS 100% OF ALL PROCEDURES
Dental insurance is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

Fact 2 — BENEFITS ARE NOT DETERMINED BY OUR OFFICE
You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee («UCR») used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

Insurance companies set their own schedules and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the «allowable» UCR Fee. Frequently this data can be three to five years old and these «allowable» fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is «overcharging» rather than say that they are «underpaying» or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

Dental Insurance

Although dental care is an important aspect of most individuals health care, it is almost universally not covered by traditional health insurance plans. Additionally, most individual dental plans that are offered out there have numerous limitations including low annual maximum limitations, long waiting periods for services, and no coverage for major services. That is why we offer a comprehensive dental insurance plan to our members, so that they can take care of this very important part of their healthcare.

Highlights

  • Comprehensive Dental Insurance Plan
  • Combined DenteMax and Careington networks
  • Can also be used in conjunction with Aetna Dental Access network
  • Over 100,000 total participating providers
  • Out of network covered at a reduced benefit
  • Covers Preventive, Basic, and Major services at 100%/80%/50%
  • $50 deductible per person and $150 deductible per family annually
  • Deductible waived for Preventive services
  • No waiting period for Preventive and Basic services
  • Only a 12 month waiting period for Major services
  • Annual max of $1,000 per person, with annual rollover benefits

How to use

  • Find a participating provider using the Provider Search
  • Present your Renaissance insurance card to the participating provider
  • Call us at (855) SURE-MED with any questions you may have

Disclosures

  • This is a group insurance policy issued to American Better Health Organization, Inc., and benefits are provided to members of the association.
  • Dental Insurance is underwritten by Renaissance Life & Health Insurance Company of America, Group Policy# 3605
  • Rollover benefit increases your annual max by $250 per year that you have at least one claim, but less than $500 in paid benefits. A maximum total annual limit of $2,000 applies after rollovers
  • This serves as a general overview of benefits, and is not comprehensive. Some exclusions may apply.
  • For a full description of coverage, limitations, and exclusions, please click here for the Description of Benefits.

What are Discount Dental Plans?

Discount dental plans are an easy and reliable way to help you save money at the dentist.

These plans give members access to significant discounts at in-network dental offices for a wide range of procedures. Discount dental plans can help you save money while offering you the quality dental care you need. Members save on preventive treatments like cleanings and x-rays, and on major treatments like root canals and bridges.

Additionally, the dentists in our network have agreed to treat our members with the same quality care, but at significantly discounted rates. When you become a member of one of our discount dental plans, you’ll pay the dentist directly when you go in for your appointment, but at a discounted rate. You don’t need to worry about filling out complex paperwork or waiting for reimbursements.

These plans are a great option for people who:

  • Do not belong to an exclusive organization
  • Do not have dental coverage through an employer
  • Have immediate dental needs
  • Have reached the annual limit for another dental program
  • Have prior dental conditions
  • Want to save on dental work

Covered California Dental Coverage

Adult dental benefits are available through family dental plans. All plans include free preventive and diagnostic care, like cleanings, X-rays and exams.

In addition to the dental coverage available through family dental plans — which make dental benefits available to single adults, married adults, families and children — children’s dental coverage is still included as part of all health insurance plans sold through Covered California. This is known as “embedded children’s dental coverage.”

Read more about family dental plans and embedded children’s dental coverage below.

How to Enroll

Family dental plans are offered during the renewal period, for Covered California members, and during open enrollment for new enrollees. Family dental plans are also available during special enrollment to new enrollees in Covered California. Adults with and without children can enroll in family dental plans, but they must purchase a health plan through Covered California in order to be eligible. See our Shop and Compare Tool to compare plans and pricing. You will need to log in to your account or create an account in order to enroll in a family dental plan.

Embedded children’s dental coverage is part of all health insurance plans sold through Covered California, so no additional enrollment is needed to receive children’s dental benefits if you already have a health insurance plan through Covered California. The dental benefits for children are part of the coverage you have purchased.

More Information About Family Dental Plans and Embedded Children’s Dental Coverage

  • Family dental plans (available to both adults and children): Dental coverage for adults is not an “essential health benefit” under the Patient Protection and Affordable Care Act, so dental coverage for adults is offered separately from the health insurance plans through family dental plans. No financial assistance is available to purchase these dental plans. Learn more about family dental plans here.
  • Embedded children’s dental coverage (benefits already included in all health plans): Dental coverage for children is an “essential health benefit” under the Affordable Care Act, so all health plans purchased through Covered California include children’s dental coverage. All consumers under 19 are automatically covered by dental benefits that are embedded in health plans purchased through Covered California. However, some parents may choose to enroll their children in an optional family dental plan for additional dental coverage. Learn more about embedded children’s dental coverage here.