Dental Insurance Articles
How State Law Affects Your Dental Insurance Costs
2010-07-09
While many Americans are well-versed in the virtue of having a thorough health insurance plan, they often find themselves with less than optimal dental coverage. This is due to a number of factors, the most common being an assumption that dental benefits are covered under traditional health insurance when this is in fact not the case. Dental plans may be sponsored by an employer or self-funded, and may also take the form of separate HMOs, PPOs or indemnity plans that are either individual or through a group organization. But no matter how a dental insurance quote is found, state insurance law will have an effect not only on how the plan it offers is managed, but on the cost of the quote itself.
It is first important to understand how dental insurance plans work. Many operate in the same way as HMO or PPO plans - clients must pick from a list of "network" providers who then administer sponsored coverage. There are often fees for joining the plan, and it will carry a monthly premium. In these plans, dentists are paid per client, not per treatment, and patients may be responsible for co-payments to use the coverage. In an indemnity plan, a portion of the dentist's actual costs for specific patients are covered, and the remaining balance is left for the patient to pay. These plans have higher deductibles and higher premiums. In addition, there are group insurance plans offered by an employer through a recognized insurance provider and plans that are administered directly by an employer themselves.
Out of all of these, only an employer-directed plan is not subject to state insurance law, as it does not fall under the category of "insurance." All other plans - HMOs, PPOs, and indemnity plans - are governed by an insurance board in state that sets out various requirements. Each state is given generous leeway in how it sets up its dental requirements for insurance companies, but there are a few common themes. First, states set out that certain "reasonable and usual" procedures must be covered, as well as detailing cancellation practices as well as enrollment requirements that must be adhered to. In effect, the state acts to ensure that clients are not unfairly denied coverage or terminated without just cause. As well, state insurance boards typically provide an option to appeal denied insurance claims after a procedure is refused.
While this insurance law is in place to protect consumers and provide a structured marketplace, they can also lead to higher dental insurance quotes if companies feel that they unfairly limit their ability to profit or do business. For this reason, comparison shopping for any dental insurance quotes is strongly recommended.