Since medical insurance plans don’t include coverage for dental services, consumers have to purchase them separately from an insurance carrier. Just like medical plans, dental plans also have specific out of pocket costs which have to be paid by members like co-pays and deductibles. This type of cost sharing keeps premiums affordable. In many cases, dental plans differ in their reimbursements based on the type of service plan they sign up for.
How does Washington dental insurance work?
In Washington State, dental plans have an annual cap on the amount of money that can be spent on a member’s care. Patients get coverage for benefits like regular checkups, x-rays, clean and other services which maintain general oral health. Some plans offer wider coverage than others for a higher fee – check out which plans cover surgery, implants and even orthodontics.
Classes of Service:
Dental plans usually have 4 categories of care which help to decide whether the treatment is diagnostic/preventive, restorative, major or complex. Orthodontic procedures are classified differently.
- Class 1: diagnostics include cleanings, exams etc. and covered 100%
- Class 2: restorative care includes fillings, root canals and periodontal work and covered 80%
- Class 3: major work like crowns, dentures etc. 50% coverage by insurance.
- Class 4: Orthodontic treatments are handled differently. The one which do cover it restrict it to members up to 19 years of age.
Types of Dental Plans:
Dental plans resemble medical ones in many aspects. They work with a network of contracted providers and offer discounted rates to members. There are few providers in Washington State and members have limited options. Members have access to a specific set of providers and costs based on the plan chosen by them.
- DHMO (Dental Health Maintenance Organization): Under this plan, you receive care from providers in the network. You will be referred to specialists based on need. There is very little paperwork involved. Patients have to just pay what they owe. DHMOs don’t have an annual maximum on coverage. Patients are liable for copays and have to meet a deductible about. With DHMO, out of pocket cost are low as long as one is in the network.
- DPPO (Dental Preferred Provider Organization): Here, members have the choice of using providers in or out of the network. Costs for out of network treatments will be higher and claims have to be submitted for reimbursement. There is little paperwork within the network.
- Dental Indemnity Plan: Under this plan, members can choose any dentist they want to see and no referrals are needed for specialists. Consumers are responsible for the deductible as well as copay for services. This type of plan has a limit on the annual maximum benefit.
- Discount Dental Plans: This cannot be considered insurance. Insurance providers contract with networks who agree to provide services at discounted rates. Discounts are available on all services including cosmetic ones and others which are not covered by other plans. Here, members pay the full costs (at discounted rates). No reimbursements or deductibles.
When you go to the dentist, always check what the treatment will cost. Estimates from insurers will give a breakdown on:
- How much the plan pays
- How much you pay
- The amount of deductible
- And the benefit maximum
As it is an estimate, it doesn’t have to be paid till the treatment is actually completed.
WA Dental Insurance Carriers
- Nationwide Life Insurance Company
- IHC Group
- LifeMap Assurance CompanyTM
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