Introduction to Dental Insurance Plans in New York
Did you know that traditional dental insurance was introduced some forty years ago? In those times, the average annual benefit was around a thousand dollars. The dental industry has progressed in a significant way since then, though many plans have not changed the maximum annual insurance benefit. Comparatively speaking, the annual benefits of Dental Insurance should have grown to around $7000 annually if we consider the average rate of inflation. Reading all of this might spark the “what does this whole darn thing got to do with me?” voice inside your head. Well, this simply means that you, unfortunately, will not receive the same amount of plan coverage which your Grandma once did (yep, that may be the reason behind her timeless smile that charms two times better than yours).
There are two common types of Dental Insurance plans in New York; the Traditional (a.k.a. Indemnity plan) and the Managed Care Plan. With the burst of demand concerning dental care, some companies or employers introduced the Direct Reimbursement Plan which has two branched benefits (a. providing savings to the company and, b. employees have greater benefit options).
Under the Traditional (Indemnity) Plan, you have the freedom to select the dentist you deem to deliver the least pain during dental visits. Kidding aside, the payment for this plan is provided on a typical fee-for-service basis. With the contract in effect, some treatments may be covered completely while some may be on partial coverage. Either way, you pay for any portion that is excluded in the individual dental insurance plan.
The most common of Managed Care Plans are DMO’s (Capitation) Plan and the PPO. Under either plans, the benefits are limited the moment you choose an ‘out of network’ plan provider. With DMO, your dentist is paid a fixed monthly fee for every client enlisted to them. This is regardless of whether they have patients or have done any treatment. When the dentist signs a contract under the PPO plan with an insurance company, she/he will accommodate clients covered in the plan. For optimum benefits, you should select the dentist from the list of network providers. If you opted to pay a higher deductibles and co-payments, then you automatically have the go signal to choose a dentist outside the network.
Today, more and more employers have come to their senses offering a Direct Reimbursement plans to their hardworking employees. If you happen to be that lucky employee, the plan enables you to receive reimbursement directly from your Boss on any dental treatments and you will have the freedom to choose the dentist you like. The company has it all settled, thus allowing you to save a great amount of penny.
In addition to the good news brought to you by Direct Reimbursement Plans, it also lowers internal expenses of the company (much to your Boss’ relief). This results to less insurance headaches for you and your dentists. It’s a win-win situation for you and the company. Too good to be true? It’s not.
