Posts in Category: Insurance

Is Pet Insurance Worth the Money? Answer These Questions About Health Insurance for Pets Before Buying

Should a pet owner purchase pet health insurance? This is a question that should be considered carefully. Vets are now able to treat many more conditions in companion animals successfully, including feline cancer, and canine diabetes. However, these treatments come with a high price tag.

Statistics show that one out of every three pets will need some type of emergency pet care every year. Two out of every three companion animals will face a serious health problem sometime in their lives. Many pet owners believe that purchasing a pet health insurance policy is the best way to be prepared for unexpected veterinary emergencies. But is this really true?

Here are questions that should be answered before buying any kind of health insurance for pets.

Is Lifelong Pet Insurance a Good Idea?

Many people wonder if they should get pet insurance for a new puppy or kitten or wait until the animal is older. This is a good question.

Just like people, pets face many more health issues as they get older. This can make it very difficult to find pet health insurance for an older animal. Most companies won’t cover a companion animal who is older than nine years. If they do, the premiums will be very high.

Is the answer to buy pet insurance when the companion animal is younger? Maybe not. That $10-a-month premium for a kitten may increase as she gets older. How much will premiums increase? Can a certain premium be locked in until the pet is ten or twelve years old?

If she is treated for a certain condition, like feline diabetes, will this condition be considered a “pre-existing condition” when it comes time to renew the policy? If so, the company may refuse to insure her any longer, or may increase the premium substantially.

Also consider the cost of premiums over the pet’s lifetime. $15 a month comes to $180 a year. If the premium remains the same for ten years, the cost would be $1800, just for premiums. The premiums will probably increase if any claims are filed. Don’t forget about the co-pays and deductibles, too.

How Much is the Deductible? How Much Co-Pay is Required?

Every pet insurance plan has a deductible, which is the amount that the owner has to pay himself. Depending on the pet’s age, the deductible may be $50 or more for each procedure (not each visit). This can add up quickly if the animal requires several procedures.

The insurance company may also require that the pet owner co-pays ten to twenty percent of the vet bill.

Ask About Caps

The maximum amount an insurance company will pay per animal per year is called a cap. There may be a cap for each covered condition, plus an annual cap and a lifetime cap for each animal. Avoid nasty surprises by learning which caps apply to the pet, or its condition.

How Long Does It Take to be Reimbursed?

Be aware that the pet owner is expected to pay the vet at the time service is rendered. The pet owner fills out the insurance form and mails it in. It can take two to four weeks, or longer, to receive reimbursement.

Before buying a policy, ask how the reimbursement is calculated. The owner may be reimbursed for a certain percentage of the vet’s bill. Or the company may have a benefit schedule that lists what it will pay for each procedure. The company may only pay a certain percentage of this amount, not a percentage of what the bill actually was.

Always Read the Fine Print

Know ahead of time which conditions are covered, and which are excluded. Is there a waiting period before the insurance goes into effect? Does the owner get to choose which vet to use? Are prescriptions covered? What about emergency care?

Every insurance company is different, and each company offers many different plans. If a pet owner decides to invest in pet health insurance, it’s important to compare plans carefully, and to read the find print to find the best value for pet insurance.

Saving Money on Health Insurance: There are ways to Lessen the Cost of Insurance Premiums

According to Bloomberg News, the national unemployment rate rose to 8.9 percent in April. Because most U.S. residents get their insurance through their employers, this means that a large number of individuals must now pay for their own health coverage.

Individuals can sign up for COBRA, which allows them to stay on their employer’s health plans for up to 18 months after they lose their jobs. COBRA, though, can be costly. According to the North Carolina Institute for Medicine, the number of uninsured residents in the United States hit 52 million in January of 2016. That’s up from 46 million individuals who did not have health insurance coverage in 2014. A big reason for this is cost: Paying for health insurance is expensive.

Fortunately, there are ways that individuals can cut the costs of health insurance.

Shop Around for Health Insurance

Individuals can save on health insurance by shopping for different health plans. Individuals can research these plans at the Web home of the National Committee for Quality Assurance. Consumers can also work with independent insurance agents or brokers to find the best plan for them. These agents don’t work with a specific insurance company, and will instead search for the most affordable plans for their clients. Working with an agent can be especially important for individuals who have preexisting medical conditions.

Stay Healthy for the Best Prices

Consumers should refrain from smoking, taking drugs or abusing alcohol if they want to pay the lowest premiums. Policyholders who smoke, for instance, are viewed by insurance companies as bigger risks than those who don’t. That’s because smokers are far more likely to need intensive medical care during their lifetimes than are non-smokers.

This doesn’t mean, though, that consumers should try to hide any existing medical conditions or health problems from their potential insurers. Insurance companies will certainly discover when individuals try to hide health issues. Instead of trying to sneak these conditions past insurers, individuals should instead give out as much information about their medical conditions as possible. For instance, individuals with a history of high blood pressure should make sure to inform potential insurers that they have changed their diet and are now taking medication to keep their condition under control.

Don’t Forget to Look at Other Options

Consumers don’t always have to obtain their health insurance through a private insurer. Trade associations or alumni clubs often offer their own group insurance plans that may boast far lower rates. Labor unions might offer the same. Paying for health insurance is never going to be cheap. But with a little research, consumers can cut a significant amount of dollars from their insurance premiums.

How to Save Money on Travel Insurance: Ways to Choose the Best Insurance Policy for a Trip Away

There are many different types of travel insurance policies. They cover the traveler for different lengths of time, for different areas of the world, and insure a bewildering a variety of different things. How can one sort out this maze?

Single Trip or Annual Policy?

Annual travel policies cover the traveler for every trip he or she takes in a year. Single trip policies are simply for one trip or holiday. For those who go away more than once a year, annual policies usually work out cheaper. When working this out, one needs to consider the possibility of weekends away as well as the main vacations. These all add up, and often the annual policy is worth having.

Europe or Worldwide Cover?

For those who are only taking a vacation in Europe it is cheaper not to get worldwide cover, and Europe-only insurance cover is significantly cheaper. However, if the traveler is going further afield, it is essential to be covered despite the cost, as in places like the USA medical expenses can be extremely high.

Specialist Policies or Activities

For those going away for long periods, such as a ‘gap year’ trip, it is probably essential to look for a specialist policy, since most annual insurance policies have a limit on the length of each trip, usually around 30 days

For travellers who plan to do ‘adventurous’ activities, such as skiing or hang gliding, a specialist insurance policy may be required. Some ordinary insurance companies do offer winter sports cover, but one may have to pay extra. For more extreme activities, it is worth checking if one can pay an extra premium to cover them, particularly if it is only for a short period of time. This is sometimes cheaper than an annual insurance policy with a specialist company.

Only Get the Cover Needed

Sometimes policies offer different amounts of cover. It is not worth paying for cover one does not need; for example, large amounts of baggage cover if the traveler is not taking away anything valuable. Sometimes it is cheaper to insure valuables along with one’s household insurance, so it is worth checking. Experts recommend £1 million of medical cover in Europe, or £2 million in the rest of the world. They also suggest personal liability cover of at least £1 million, £1,500 baggage cover, and £3,000 cancellation insurance. But a good rule of thumb is not to buy what is not required.

Checking to See if One is Already Covered

Some banks offer free travel insurance with certain accounts, so for those who have one of these, there is no point in paying twice so long as what one needs is actually covered. However, the travel accident insurance offered by some credit card companies only covers the individual in certain very specific circumstances, so one should not rely on it.

Finally, the individual should be upfront about any medical conditions or similar things, as otherwise the policy could be invalidated.

Once the traveler has adequate insurance cover, he or she can go on that planned holiday safely, knowing that if anything goes wrong at least there should not be an expensive bill to be paid. And this peace of mind is at least as important as the good feeling one gets after a restful and relaxing holiday.

How To Save Money On Your Commercial Vehicle Insurance

Do you use vans or other vehicles as part of your business?

You do not have to run a huge multi-million pound business for fleet van insurance to be appropriate for you. Many insurers classify as few as two vans or trucks as a ‘fleet.’ Others will offer preferential rates and terms for anything over five to ten vans covered under one fleet van insurance policy.

Commercial vehicles are important company assets

Vans and trucks are vital components of many firms and are probably some of your most valuable company assets. This is why it is crucially important that they are fully protected. Many companies find that a fleet van or truck insurance policy is the best way to achieve this.

In the same way that your business can suffer if your workforce is absent through sickness, having your commercial vehicles off the road through theft or an accident can negatively affect your business. Can your business afford for its vans or other commercial vehicles to be off the road?

Fleet truck insurance is the perfect solution answer if you are a company with a number of vans or trucks. One fleet van insurance policy can cover your whole range of commercial vehicles, saving you both time and money. You only have to deal with one insurance company rather than having to correspond with dozens of different insurers for your various commercial vehicles.

Discounts and fleet van insurance cover

Fleet truck insurance policies will also save you money. Many companies offer discounts if you cover several vans, trucks or other commercial vehicles under one fleet van insurance policy. Discounts of 10% or more are not uncommon.

Whilst the cost of insurance is important, it is also vital that you consider what the various fleet van insurance policies cover. Many will include fire and theft, legal expenses and goods in transit. You may also benefit from a policy that offers a replacement vehicle if you rely on your vans being on the road at all times.

As anyone with a fleet of trucks will know, insuring your vehicles separately can be both costly and complicated. There is no guarantee that each of the policies provides the same cover as the others and it can take a huge amount of the time to review and renew each individual policy. With a fleet van or truck insurance policy, all your commercial vehicles are covered under one comprehensive policy, saving you both time and money.

Consumers Versus Health Insurance Companies

On September 23, 2010, several very important provisions of the Affordable Health Care Act, signed by President Barack Obama on March 23, 2010, became effective. This Act is part of the healthcare reform agenda of the currently in-office Democrats. These provisions provide greater protection to the consumer by reigning in long practiced atrocities committed by greedy health insurance companies. The following is a list of what insurance companies can no longer do, followed by what consumers can now do.

Insurers cannot:

  • Deny coverage to children with pre-existing conditions, such as asthma, diabetes or heart disease.

  • Place lifetime limits or caps on benefits.

  • Cancel a health insurance policy without proving fraud.

  • Deny medical claims without providing the consumer with a chance to appeal the decision.

Consumers can now:

  • Receive free preventative services such as immunization shots and office visit check-ups.

  • Keep their children on their parents’ medical plan up to the age of 26 years old.

  • Select their own primary care, OB/Gyn and pediatrician without interference from the insurance company.

  • Use the nearest emergency room without being penalized by the insurer.

Furthermore, individual states can offer a Pre-Existing Condition Insurance Plan. These plans focus on people with pre-existing health conditions and who have not been able to be approved by any other insurer for any other reason but for their health condition; the person must be a U.S. citizen or national, and must not have been able to be approved for insurance for at least the prior 6 months. This plan covers a wide range of pre-existing health conditions, provides primary and specialty care, hospital benefits, and prescription drugs.

Unfortunately, the prohibitive part of the Pre-Existing Condition Insurance Plan is its cost. For a family of four, the premium can be close to $1,000 per month, which is still beyond the means of most consumers.

Consumer Suffering

Many citizens have suffered at the hands of the health insurance companies. Insurers have cancelled or completely revoked policies from the policy date of inception for inconsequential reasons.

For example, in the case of Denise and Stephen Wheeler versus Nationwide Insurance Company, Mr. and Mrs. Wheeler were approved for health insurance in December. In May 2006 Mrs. Wheeler was taken via ambulance to the hospital due to a perforated ulcer, which she was unaware existed. She endured five hours of surgery where the perforation was repaired. A short time after the surgery, her health insurance carrier requested additional health insurance information from her. According to court documents, Mrs. Wheeler had not disclosed an emergency room and Ob/Gyn visit that happened two months prior, but was caused by heavy menstrual bleeding. The insurer contended that they would not have approved the insurance had they had known of the condition with her menstrual cycle. The Wheelers were left with a $30,000 hospital and medical bill.

Another example is the case of Susan and Tony Seals versus HealthNet. In March of 2003, Mr. and Mrs. Seals applied for and were approved for health insurance through HealthNet effective April 1, 2003. Shortly thereafter, Mrs. Seals was informed that she was pregnant and gave birth to a daughter in October 2003. Mother and daughter had difficulties during the labor and delivery process where the baby had to be resuscitated immediately after birth and sustained brain damage. The Seals medical expenses came to $140,000. At this point, HealthNet decided to review their original application and determined that Mrs. Seals was two weeks off when she answered the question requesting the date of her last menstrual cycle.

The Seals brought suit against HealthNet, and won. They received $95,000 toward medical bills and $1,000,000 in a trust fund toward care of their daughter who will need constant care for the entirety of her life.

These are just two of the hundreds of policy cancellations, revocations, and lawsuits brought against the health insurance industry. They have had a choke hold on the American public long enough. Even after being fined millions of dollars in the recent past because of their underhanded practices, their practice continued.

Now, with the new portion of the Affordable Health Insurance Act finally in place, consumers can begin to feel more secure that their protection is first and foremost. By the year 2014, all of the portions of this Act will be in place, which will further protect the public from the greedy health insurers.

 

After speaking with various individuals within the medical professions, many oppose this Act. They claim that this will inhibit their treatments and care toward patients. But if you carefully read all portions of this Act, you will find that it protects the general public from underhandedness of health insurers and limits medical costs that can be charged by doctors. We, the consumers, can now be assured that we are no longer at the mercy of the giant health insurers.

Co-Payments vs. Coinsurance

What Does an Insured Pay When They Have Health Insurance?

 

The health insurance industry uses many different terms and understanding them is key to understanding what you are required to pay and what the insurance company will pay. Going to the doctor when you are sick can involve lab tests as well as prescriptions and sometimes being referred to a specialist. Each place you go, you will be required to pay something.

 

  • Co-Payments

 

    • Co-payments are normally found in managed care plans, such as an HMO (Health Maintenance Organization). They are specified amounts of money that you will pay for each doctor visit. Some have different co-payments for primary physician visits and specialists. Co-payments can vary in amounts, depending on the terms of your policy, from $5, $10, $20, up to $40. Each time you visit the doctor you will be required to pay this amount. In an HMO, the insurance company will pay the balance directly to the physician.
    • In addition to doctor’s visits, prescriptions usually carry a co-payment and often there are several levels depending on the type of medication and whether the medication is available in generic form. There can be up to three levels of co-payments for prescription medication. It may be listed in the format 15/25/40. This generally means that for generic drugs, you would be required to pay $15. Other prescription co-payments would depend on the medication being prescribed. Your insurance company can supply you with a list of which medications will require a $25 co-payment and which would require $40 to be paid.
    • Other services, such as emergency room, laboratory tests and specialists may have their own co-payment. Your policy will have each listed.

 

  • Coinsurance

 

  • Coinsurance is sharing the cost of medical care between the insured and the insurance company. This is found in major medical policies. Coinsurance would be paid after the insured has satisfied their annual deductible. The most common coinsurance would be 80/20. In this case, the insurance company would pay 80% of the medical costs and the insured would be responsible for the remaining 20%. Sometimes 70/30 or 90/10 coinsurances are seen in policies.
  • Since a large medical bill, such as a hospitalization, could lead to a large bill for the insured (20% of a $20,000 hospital bill would amount to $4000), most policies include a stop-loss or maximum out-of-pocket amount annually. This may be $1000, $2000 or a different amount, depending on your policy. Deductibles do not count toward your out-of-pocket maximum, however, each time you pay 20% of your bill, it will count toward it. With this maximum, you will know the most you can pay for medical bills in any given year.
  • Some people will use the terms co-payment and coinsurance interchangeably, however, there are distinct differences and meanings to both. Understanding the difference can help you to better compare insurance plans and determine what is best for your needs and your family’s needs.

Buying Unemployed Medical Coverage

Your Options for Unemployment Health Benefits After Losing Your Job

 

If you’re unemployed and you need medical coverage, you have some solid healthcare options to choose from.

  • You can buy unemployed medical insurance online or in a local health insurance agent’s office. Make sure you only use reputable health insurance websites to buy an individual health insurance policy.
  • Get unemployed healthcare from your ex-employer’s insurer when you sign up for COBRA. COBRA allows you to continue your health insurance for many months after the end of your employment. Take note, COBRA is a very expensive form of unemployed medical coverage.
  • Unemployment insurance is available in more than 40 states through state continuation insurance. Similar to COBRA, unemployed group health plans through state continuation are for ex-employees of companies employing less than 20 people. Eligibility for unemployment state continuation insurance varies by state.
  • Conversions are another way that your ex-employer’s healthcare might be able to help you when you’re unemployed. Insurance group health plans that offer conversion allow you to convert unemployment group health benefits to a non-group insurance policy.
  • You may be eligible for job loss insurance through HIPAA (Health Insurance Portability and Accountability Act of 1996). If you’re unemployed and eligible for HIPAA, you’re guaranteed two health insurance policy offers. Check with your state department of insurance to determine eligibility criteria.
  • If you are low income, you may be eligible for unemployed healthcare through Medicaid. Medicaid guidelines vary by state.
  • High-risk pools offer medical coverage for the unemployed in more than 30 states. High-pools are a very expensive form of health insurance for the unemployed and only have limited enrollment.

Help diffuse the high cost of prescriptions with unemployed health benefits.

  • Unemployment health benefits like prescription assistance may be available to you through a pharmaceutical company. Prescription assistance helps people without insurance get the prescriptions they need.
  • Check with local pharmacies to see what kind of discount drug plans they offer the unemployed. In order to compete with national pharmacies and website service, a number of smaller, locally-owned pharmacies have started discount drug plans that offer great value to you and your family.
  • If you are unemployed and have an individual health insurance policy, COBRA or some other job loss insurance, check to see if mail-in prescriptions are available. With mail-in prescriptions, you get three months’ worth of medicine for the same price as one month’s worth of medicine at a local pharmacy.

Notes about job loss insurance:

  • State rights, regulations and availability of job loss insurance vary. Contact your state department of insurance to determine eligibility.
  • Understand the difference between job loss insurance and unemployed discount health plans. Discount health plans are not the same thing as health insurance.

Travel Health Insurance: Preparing for Medical Needs While on Vacation

Most people enjoy taking car trips to nearby getaways or flying to see entirely new vistas. And most vacations go smoothly, with only minor inconveniences. Because they don’t expect anything bad to happen on their vacations, most people travel without thinking about their health insurance.

But imagine becoming ill while visiting a foreign country. What if a family member breaks a leg while skiing? Or a fishing trip ends in a boating accident? It’s important to know whether existing health insurance would cover a medical emergency far from home.

Existing Health Insurance May Be Enough

Those who already have health insurance should review the contract, call the insurance agent who sold the policy, or contact the insurer’s customer service department to find out if benefits apply while traveling. Some major insurance carriers do provide access to medical care for their customers who are away from home, but restrictions and exclusions may apply. All travelers should carry copies of their insurance policy and member ID card with them, and find out if they should bring additional forms of identification. Also be sure to bring any special contact information for the insurance company’s out-of-town benefits program.

Get details on what services are covered while out of the home area, including hospital care, emergency room services, doctor’s office visits and prescription drugs. Something as simple as a prescription for an antibiotic could cost hundreds of dollars without valid insurance. In addition, many standard insurance policies do not cover the cost of transporting a person home after a medical emergency.

How to Choose a Travel Health Insurance Policy

Those who are not currently insured or who do not have travel benefits should consider a travel health policy. There are four general policy types, ranging from basic to deluxe international policies.

 

  1. 1) Basic Policy. A basic travel medical policy should protect a traveler (and family, if applicable) from the financial consequences of an illness or accident that strikes when they’re far from home. The policy should cover hospital and surgical costs, physician visits, medications and dental care, and should also include evacuation insurance.
  2. All-inclusive Travel Insurance. The next level of coverage is a trip protection policy. These comprehensive plans provide the same type of hospitalization and office visit coverage of a basic policy, with the important additions of trip cancellation and interruption insurance, medical evacuation services, baggage protection and other benefits. Travelers may also choose add-ons like emergency cash advances, translation services, access to legal assistance, extra protection for airline accidents and acts of terrorism, and help in recovering lost tickets or passports.
  3. Specialized Insurance for Students. Americans age 64 or younger who are studying or conducting academic research abroad — or international students traveling to the United States to study — may be interested in a health insurance policy designed especially for international students. These policies usually offer benefits comparable to a traditional major medical plan, as well as medical evacuation coverage, repatriation (sending home) of remains in the event of a death, translation assistance and specialized health and security information related to the country being visited.
  4. International Travel Health Insurance for Long-term Visits. A fourth type of travel policy is a renewable international plan for individuals or families who will be staying in a foreign country for a year or more, such as for an extended job assignment.

Buying Travel Health Insurance Online

Purchasing a travel policy on the internet has advantages and disadvantages. Information and convenience are the biggest benefits of online shopping. Customer service is less strong.

Many internet travel sites also sell travel health insurance policies. But insurance is not their main focus, so they may offer fewer choices of benefits or rates. Travelers who already have a relationship with a travel agent may wish to ask if the agency also sells travel health policies. Many licensed travel agents offer these policies, and because travel is their specialty, they can advise on what type of policy and what level of benefits are right for each client.

Customer service is the heart of a travel agent’s business. An agent can be a valuable source of personal help in a crisis. He or she will likely have industry contacts and experience in dealing with people and organizations in distant places. If a client forgets to bring important documents or contact information on a trip, the travel agent will have that information available and should have a toll-free phone number that clients can call for help.

Those who don’t have an existing relationship with a travel agent may want to check with one of their professional trade associations, such as the American Society of Travel Agents (asta.org) or the Institute of Certified Travel Agents (icta.com). Another industry website at TravelSense.org offers visitors a way to search for an agent with specialized credentials.

Buying Travel Coverage Through a Credit Card

Some credit card companies offer health insurance as an addition to other services. For example, travelers who hold American Express business cards may be eligible for travel accident insurance and the company’s “global assist program” for international emergencies. A traveler who is planning to book a trip using a credit card should check with the company’s customer service to find out about these added services.

Hopefully, the very worst thing that happens on a vacation will be something as simple as a misplaced suitcase. And if so … a good travel insurance policy includes the baggage replacement benefit to cover it!

Business Health Insurance Choices: Before You Buy Guide: Small Business Group Health Coverage Plans

There are a number of choices available for small business group health insurance. Taking the time to do some research can make the process of finding a solid employees’ healthcare plan a lot easier.

Determine Small Business Group Health Insurance Needs First

It’s pretty pointless for a small business to purchase a pricey group health insurance plan, to then find out that half of the employees like their spouse’s health insurance just fine, thank you, and have no intention of switching plans. Determine what coverages and policy types are needed first. Surveying employees to find out what they’re looking for in a healthcare plan can help.

Verify Business Health Insurance Company Licensure

Check with the state department of insurance to ensure that a business health insurance company is properly licensed. Never, ever deal with any small business health insurance company that isn’t licensed, no matter how good the deal. It’s no deal if there’s a group health insurance claim.

Rate the Health Insurance Company before Buying an Employees Healthcare Plan

Quickly find out how a business health insurance carrier stacks up by visiting www.ambest.com. The A.M. Best Company supplies ratings for insurance companies based upon financial strength and credit obligations. Moody’s, Ward’s and Standard & Poor’s offer even more information about employees’ healthcare plan companies.

Ask for Small Group Health Insurance Referrals

Existing clients of a new insurance agent or small group health insurance company can attest to their quality of service. Other business owners can provide information about who they use for business health insurance companies and provide company contacts who can offer information about billing, claims and customer service. It’s worth the time to get referrals and more information before buying an employees’ healthcare plan.

Look for Small Business Group Health Insurance Companies Online

Review small business group health insurance company websites. It only takes a minute to do, and provides a wealth of information about insurance providers. Find out if a small group health insurance is Web-enabled, allowing online payments and questions. Old press releases can tell the tale of how the small business group health insurance company reacted during Katrina and other natural disasters. Investor information, products insured and the claims and customer service sections of a business health insurance company website can provide further detail.

Getting the Most from Small Business Group Health Coverage

Sometimes, the best deal for small business group health coverage isn’t a good deal at all. Finding an employees’ healthcare plan depends upon more than just cost. Cost-savings should be married with a small business group health coverage plan known for its superior customer service.

Analyzing Dental Insurance Coverage: How to Select the Best Dental Plan for Your Needs

Because policy limits, deductibles, rand financial reimbursement caps vary, people have to make smart decisions and pay special attention to the fine details of their dental insurance plan before signing on the dotted line. When performing an analysis to decide which dental insurance plan is best, here are a few things to consider.

Routine and Preventative Maintenance Coverage

Because the dental insurance carrier recognizes the benefit and cost savings of preventative maintenance, annual checkups and cleanings are often covered 100%. Find out, however, how many well care visits per year are covered. Some policies cover one per year while others cover one every six months.

Usual, Customary and Reasonable Reimbursement (UCR)

Dental insurance companies establish a standardized chart upon which they base reimbursement for dental procedures. Each company sets its own UCR, therefore it is important for insurance seekers to review the insurance provider’s UCR table and compare it with the dental prices in a given area. Unfortunately, the usual, customary and reasonable reimbursement chart and actual dental procedure costs rarely match. Most often the dental procedure will cost more than the UCR listed on the insurance company’s schedule. The difference ends up coming out of the policyholder’s pocket.

Annual Benefit Cap

It is customary for dental insurance plans to limit the dollar amount of procedures a patient can undergo one year. For individuals who regularly visit the dentist to perform preventive procedures such as regular cleanings and fluoride treatment, the annual benefit cap does not pose a problem.

Families and individuals who have dental problems that go above and beyond the normal preventative measures and occasional filling may reach and exceed the annual benefit cap. Many insurance companies offer coverage on a sliding scale basis. For example, they may pay 100% of preventative measures, 80% of basic restorative services and 50% of major restorative services. Therefore, it’s best to coordinate care with the dentist to spread the work out over the course of several policy terms to in order to minimize out of pocket expense and maximize the dental insurance coverage.

Lifetime Benefit Cap

Further to the annual benefit cap, which gets replenished each year, dental insurance companies also apply lifetime caps for certain procedures. It is common for dental insurance companies to put a lifetime cap on orthodontic coverage. Therefore, if a child needs braces to the tune of $5,000 and the policy only covers $2,000 (lifetime cap). The $2,000 is not replenished the following year and becomes an out of pocket expense.

Dental Insurance Deductibles

Dental plans vary, but it is important to assess the true cost of purchasing a dental plan. In addition to the annual/lifetime caps and UCR, patients must review the deductible requirements and whether or not the deductible applies on a per person or a per family basis. Depending on the number of people in the family and the amount of dental work to be performed, the applicable deductible can be a substantial out of pocket expense.

If presented with more than one dental insurance option, it is prudent for one to take time and analyze each program. The decision should not be made hastily.