What To Do When Your Employer’s Dental Insurance Plan Changes

January 5, 2017

Seeing changes in your dental coverage is not unusual. As companies re-negotiate their contracts with insurance providers, you may see a shift in your family’s coverage, which we know can be confusing and frustrating. It can be for dental offices as well!

But, not to worry. PERFECT TEETH accepts nearly all insurance plans — and we have an affordable dental plan for those without dental insurance, but that’s a topic for a different blog post. For now, let’s look at how to review the changes in your dental insurance plan.

When to Expect Dental Coverage Changes

Changes to insurance plans are usually presented to you (and everyone else included in the covered group) at the end of the plan year which is many times the end of the calendar year during an open-enrollment period. At this time, your employer should present information on what is new and what is changing in your plan. During open enrollment, read the fine print so you know all you need to know.

If the open-enrollment period has passed, then your coverage is set for the year. You’ll have a chance to review your dental insurance again during the next open-enrollment period.

What Questions to Ask About a Different Dental Insurance Plan

We like this list of questions presented by the American Dental Association. It’s a list of questions to consider during the open-enrollment period, too. For instance:

  • Can you pick your own dentist or do you have to use a dentist from a pre-determined list of dentists?
  • Can you stay with your current family dentist office or will you have to change dentists? (See info on in-network vs. out-of-network below.)
  • What routine and major dental care will be covered (including cleanings, x-rays, surgery, and orthodontics)?
  • If you need to see a specialist, will that be covered by your new dental insurance plan?
  • Will a pre-existing condition prevent you from having dental care paid for by the insurance company?

If the new insurance documentation you receive is not clear in answering these questions, speak to your employer.

Understanding What “In-Network “and “Out-of-Network” Means for Dental Care

“In-network” and “out-of-network” are common terms in the insurance world. “In-network” means a dentist is on a pre-approved list of providers in your plan. “Out-of-network” means a dentist is not on that pre-approved list.

Typically, you will receive greater benefits by using an in-network dentist. Make sure you understand whether or not your dental insurance plan will cover costs associated with visits to an out-of-network dentist. Some plans do, but others won’t, or they will require you to pay up-front and then the insurance company will reimburse you.

Again, if you aren’t sure, speak to your employer and ask if your family dentist is in-network or out-of-network and whether or not your future dental care will be covered.

What If You Don’t Want to Use Your Employer’s Dental Insurance?

Ideally, your company’s dental plan will save you money and allow you to see your preferred dentist, but if that’s not the case, you do have options, especially since you may find it’s reasonable to pay out-of-pocket or purchase your own dental plan.

If you find your employer’s dental insurance is not what you want, call your dentist’s office to see what they can offer you. At PERFECT TEETH, we are happy to work with you whether we are an in-network provider, out-of-network provider, or you don’t have an employer insurance plan at all.

Find the PERFECT TEETH dental office near you to learn more!