Dental Ins

Dental Insurance and How They Work in Connecticut

Dental plans in Connecticut are usually issued with no health questions.
Dental plans are able to do this because the dental policy or dental plan will limit:

  • What dental benefits are covered
  • When the benefits are covered
  • What dentist you can use without penalties
  • What your cost or deductible will apply to the dental work

You can purchase a dental plan as an individual, as a family, as a separate policy or as a dental rider.

Some plans cover dental Implants, but many don’t. Lets take a look.

Common dental procedure classifications:

A. Each dental plan will describe what procedures they consider to be preventative , basic, major, etc. The one procedure that is common to look for is a root canal, or a dental implant. A dental plan may classify a root canal as a basic or a major procedure/benefit.

B. It is common to put waiting periods on types of procedures. For example, Preventative and Basic procedures may only be covered the first 12 months. Major procedures may be covered after 12 months. Some Medicare Dental plans do not have a waiting period.

NOTE: If you have a prior dental plan, some dental plans will give you credit for the time you had dental insurance. They usually look back 12 months for coverage. You will be required to provide proof of prior coverage, usually a dental card.

C. It is also common to have a percentage limitation for the specific types or classifications of procedures. For example, there may be 100% coverage for preventative care, 80% for Basic procedures, and 50% for major procedures.

D. It is also common for the dental insurance plan to put monetary limits for specific procedures if you go out of network . The dental payment term that may be used is “usual and customary charges”.

E. It is also common to have a yearly deductible per person. For example $50 per person per year.
Preventative care may not have a deductible.

F. It is common, for a yearly limit for all dental work done that resets every January 1st. For example, they may set a limit for all dental benefits per calendar year to $1,000, $1500, or $3000, per person per year that starts January 1st and ends December 31st. Recently I have noticed some dental plans set an amount per quarter. For example $1500 per year but $375 every 3 months.

Why purchase a dental plan?
Dental insurance plans are considered a health insurance plan by the Federal Government and therefore may be tax deductible for you. If the dentist is in the Network of providers, a reduced fee has been negotiated by the dental plan, So you get your covered dental work done for less money.

What is a discount dental plan?
A discount dental plan is where you pay just to use a network of dentists. The discount plan does not pay the dentists or providers for dental care. Discount plans are not insurance, but they are regulated by the State of Connecticut. Sometimes these companies hide that they are just a discount plan.

Some Parting Words

When looking for a dental plan, it is good to face the fact that Dentists are in the business to make money, and lots of money makes them happy. I have found that some dentists are not in any dental plan networks. I also have found that those dentists that are in a dental plan network . . . are usually in many dental networks.

I do not recommend researching on the internet for answers to specific dental plan benefits. Websites and brochures may not be the most up to date or may apply to a different state. However, knowing you are going to research anyway, You should know that the brochures and websites give you the coverage and benefits . . . but “the exclusions” take away the coverage. The wording for exclusions may be hidden behind phrases like:” this brochure/ website is a general explanation of coverage. Please refer to your policy for exact information.”

If you go directly to a dental plan, I remind you the employees are paid to keep you with their employer. Most recently, a health plan in Connecticut reduced their $1000 Comprehensive dental plan that covered fillings, crowns, bridges, etc. . . . . to covering ONLY PREVENTATIVE CARE such as cleanings, xrays, and exams only. People were told they still had a dental plan. This was not a proper answer to me.

Lastly, I have to say that as an insurance broker, I am aware of the dental plan and the dental plan rider exclusions and the specific differences between dental plans and can save you time and help you get the coverage’s you are looking for. The price for a dental plan is the same whether you use an insurance broker or not. The insurance company pays us directly. So you are paying for help, you might as well have someone like us helping you.

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