Dental insurance
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Dental insurance Document Transcript

  • 1. TYBBI SEM-VI DENTAL INSURANCE . INTRODUCTION TO DENTAL INSURANCE As we know that poor care of mouth and teeth can affect a person general health and well being throughout his life. Generally, when this problem comes, there is a need to start seeing a dentist regularly…and everyone knows a hole in tooth can put a bigger hole in wallet…that costs money! Because dental disease is so common, being protected by dental insurance and using it wisely is essential safeguards for any individual or a family. Among other insurances “Dental insurance” is rather unique. First, its low cost makes dental insurance highly affordable for individuals and families. Second, because dental insurance encourages and generally pays for regular check-ups, many people who purchase protection start to benefit immediately. Dental plans usually cover a wide range of services. These include preventive care, emergency care, and procedures such as crowns, root canals, periodontics, orthodontics, oral surgery, and more. KES SHROFF COLLEGE OF ARTS& COMMERCE 1
  • 2. TYBBI SEM-VI DENTAL INSURANCE (a) Traditional Dental Insurance: - Dental insurance is sometimes attached to healthcare packages that accompany jobs at larger companies. However, more often these days, dental and vision is not part of company health packages. This means that it is up to the individual to get his or her own coverage. (b) (c) Preventative Dental Care: - Of course, once a person has dental insurance he has to make sure that he visits the dentist on a regular (twice a year) basis! Still, if a person is paying even the most affordable premiums it is another incentive to make sure that he gets the preventive work done. It will really cut down the chances of having major and costly work done in the future. Dental plans have always been an utmost necessity. Even for the most frugal or fearful person, tooth and gum problems are hard to ignore. A person rely on his teeth and gums every time he eat KES SHROFF COLLEGE OF ARTS& COMMERCE 2
  • 3. TYBBI SEM-VI DENTAL INSURANCE or drink, so there is nothing more miserable than having dental problems that go untreated. In today's uncertain economic times, however, finding affordable dental care has become quite a challenge. Fewer people than ever have insurance and even fewer have dental insurance. This is because of the prohibitive cost of most traditional dental insurance plans. WHY IT IS NEEDED? Why is dental insurance needed? Well, the most important reason is of course that treating dental problems is expensive. Second reason is that dental diseases are so common and yet preventable those with a dental insurance cover that stresses on preventive care we can enjoy trouble free oral health. Almost every member of the family needs to visit a dentist for routine check-ups every year. Many times it's more frequent that that. With out dental insurance we should be prepared to pay for these costs. But having a family dental insurance cover will protect one family by covering the costs of our dental care. It's an essential safeguard for one family's dental health. Preventive care, including regular checkups and cleanings, is very important to maintain good dental health. With regular visits to the dentist, problems can be diagnosed early and treated without extensive KES SHROFF COLLEGE OF ARTS& COMMERCE 3
  • 4. TYBBI SEM-VI DENTAL INSURANCE testing or elaborate and expensive procedures. That is why dental care costs are much lower when compared to medical care. A good dental insurance cover is an ideal safety to help us keep medical and dental costs under control. So, invest wisely and choose a dental insurance plan that meets family needs. A variety of online dental insurance plans is now available and is quite simple to buy too. KES SHROFF COLLEGE OF ARTS& COMMERCE 4
  • 5. TYBBI SEM-VI DENTAL INSURANCE 3. DENTAL PLANS Dental plans and programs offered by many are not health insurance policies. They provide discounts at certain health care providers for medical services. Some of the Dental Plans providers do not make payments directly to the providers of medical services. The Plan or Program member is obligated to pay for all health care services but will receive a discount from those health care providers who are in contract with the plan organization. Each insurance company has different types of dental plans. It is impossible to generalize the types of plans because what works for one company doesn’t work for another for reasons of different types of employers. But there are some common features that can be noticed in most dental plans. Fee-for-service plan is a quite common plan (or the variation of it). Many discount dental plan offer savings of certain percentage on most dental procedures. When visiting a participating dental provider, a patient will be charged according to the plan discounted schedule fee. With fee-for- service plan a patient may visit any licensed dentist and change dentists at any time without notifying their insurance company. Sometimes these costs may be lower if a person visiting a dentist that is a dentist sponsored by a particular insurance company. A variation of fee-for-service plan works almost in the same way where a dentist is paid for each service provided and the patient may be responsible for a deductible or co-payment for certain services as well as KES SHROFF COLLEGE OF ARTS& COMMERCE 5
  • 6. TYBBI SEM-VI DENTAL INSURANCE amounts above annual maximum. While the patient may visit any licensed dentist and change dentists at any time without notifying his insurance company, he will maximize his benefits when visiting a dentist specified by his insurance company. An insurance company will pay its portion directly to the dentist to make things easier for him. A patient will most likely get a notice explaining his portion of the bill, and than will pay the dentist only that amount that is specified on the bill. • Choosing a dental plan When looking for an appropriate dental benefits plan, it is important to do the research and make a knowledgeable decision. It is a good idea to contact several different insurance carriers and spend time asking questions and comparing packages. Most dental coverage tries to ensure people can receive regular preventive care. Choosing the right dental plan can help to save a lot of money over the course of one year or several years. A person should be sure to take advantage of easy-to-use plan comparison chart to compare the savings and features of each discount dental plan in his area before deciding on a plan that is best for him. Contrary to many medical ailments, dental problems are generally preventable. Through preventive care such as good dental hygiene, regular checkups and teeth cleanings, problems can be diagnosed early and treated without extensive testing. Therefore, the cost of dental insurance is usually lower than that of medical insurance. KES SHROFF COLLEGE OF ARTS& COMMERCE 6
  • 7. TYBBI SEM-VI DENTAL INSURANCE • Routine treatments covered by the dental plan Check to see how much will have to pay out of pocket alongside the dental coverage. There is a broad range of treatments considered routine, and one can obtain a list of these from different dental insurance carriers. • Major dental or emergency care is covered by the plan Not only one want to know what major care is covered, but one should also ask the amount of co-pay (money out of pocket). Dental plans are often not as generous with major dental care or emergency coverage since their focus is largely on preventive treatment. Section I.2 PREVENTION IS BETTER THAN CURE We can find that Dental plans emphasize prevention whereas medical insurance is designed to cover the costs of serious illnesses. Why do dental plans emphasize prevention? Simple it's because dental diseases are preventable. Dental problems do not require elaborate testing and complex equipment. Usually all it needs is an examination by a dentist and some X-rays to diagnose most dental ailments. Dental plans works quite differently from medical insurance. Most dental plans are designed so that patients receive regular preventive care. High quality dental care rarely requires the complex, multiple resources often required by medical care. As dental problems are preventable, dental benefits plans are structured to encourage patients to KES SHROFF COLLEGE OF ARTS& COMMERCE 7
  • 8. TYBBI SEM-VI DENTAL INSURANCE get the regular, routine care that is important in preventing the onset of serious dental ailments. Now days we can notice that dental plans emphasize that we assume more costs for dental treatment than for preventive care. Yes, it is much cheaper and safer to prevent dental disease than to cure it. In fact statistics show that preventive care saved nearly 100 billion dollars for America in the 80's. Choose wisely choose dental plans that offer preventive care. It's definitely cheaper for us in the long term. Dental plans offer a comprehensive dental insurance cover with an emphasis on preventive care. THE THIRD PARTY IN INDIVIDUAL DENTAL PLAN In any individual dental plan, there are usually three parties: 1. We, the patient 2. The dentist providing care 3. And a third party with whom our employer or we contracts for coverage. The primary responsibility of the third party is to provide the financial foundation for our individual dental plan. There are three types of third parties in any individual dental plan. Dental Service Corporations: These are the not-for-profit organizations that negotiate and administer contracts for individual dental plan plans or specific groups of patients. Delta Dental Plan and Blue Cross/Blue Shield Plans are examples of this third party type. KES SHROFF COLLEGE OF ARTS& COMMERCE 8
  • 9. TYBBI SEM-VI DENTAL INSURANCE Insurance Carriers: These are the for-profit companies who underwrite the financial risk of, and process payment claims for, dental services. Carriers contract with individual dental plan seekers or patient groups to offer a variety of dental benefits packages, often including both fee-for- service and managed care plans. Self-Funded Insurers: These companies use their own funds to underwrite the expense of providing dental care to their employees. The company pays for the dental costs of its employees, usually with limitations on services and fixed-dollar allocations. Being informed and selecting an individual dental plan suited for our needs is the wisest decision that we can take in the management of our dental health. SMALL BUSINESS DENTAL PLAN If we own a small business and would like to offer dental cover for our employees we could get group dental plans. We get discounts for group cover and all our employees and our self can benefit from the lower costs for membership. The small business dental plans can also be tailored to suit the needs of our employees. Dental insurance cover is available only to those Americans whose employers offer the dental cover as part of medical insurance cover. The rest have to do with dental discount plans. The small business dental plans are a real boon to small employers and their employees who would otherwise have no dental cover. Dental treatment is expensive if dental problems are detected late. The sooner they are treated the lesser the cost. Best of all is to prevent dental problems. As an employer we should tailor our small business dental plan emphasizing on prevention. Regular check-ups, dental cleanings and KES SHROFF COLLEGE OF ARTS& COMMERCE 9
  • 10. TYBBI SEM-VI DENTAL INSURANCE routine visits to the dentist should all be part of the small business dental plan. A group small business dental plan is the best bet against dental emergencies. As a small business owner even the loss of few man-days can cause serious disruptions in our schedule and loss of long-term customer trust if we do not deliver on time. A few dollars invested in a small business dental plan can potentially save us thousands of dollars. So do not hesitate to invest in-group small business dental plan and what's more we can avail of discounts too on the membership fees. KES SHROFF COLLEGE OF ARTS& COMMERCE 10
  • 11. TYBBI SEM-VI DENTAL INSURANCE 4. DENTAL INSURANCE PLAN Dental insurance plan models are changing from traditional dental insurance to latest dental insurance plans. In traditional dental insurance plans, first we pay a premium, usually every month. Then we have to meet the deductible. Then, and only then, we can count on the insurance company paying for our care or can we. People get fed up with the rules of traditional dental insurance plans. But now days of traditional dental insurance are over. There are alternatives to the costly premiums and deductibles of insurance companies. This is the fee-for-services plan. Like health insurance plans, dental insurance plans are usually categorized as either Indemnity or managed-care plans. The major difference between these two concerned are choice of dental care providers, out-of-pocket costs and how bills are paid. Typically, Indemnity plans offer a broader selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that we may have to pay up front and then obtain reimbursement from our insurance company). Managed-care plans typically maintain dental provider networks. Although there is no one "best" dental insurance plan, some plans may work better for us and our family than others. When reviewing our dental insurance options, here are a few questions we need to ask our self: • How much will dental insurance plan cost on a monthly basis? • Which dentists participate in the dental insurance plan's network? • Is there waiting period for certain procedures? KES SHROFF COLLEGE OF ARTS& COMMERCE 11
  • 12. TYBBI SEM-VI DENTAL INSURANCE • If I used a dentist outside the dental insurance plan's network, how much will I have to pay? INDIVIDUAL DENTAL INSURANCE Today, many people are looking at individual dental insurance schemes. Traditional individual dental insurance is often believed to be the best way to pay for dental expenses. And while individual dental insurance is a good option when sponsored by our employer, it is often not very cost effective when paying for it our self. Most individual dental insurance plans require us to meet waiting periods and deductibles before having major and sometimes even minor restorative work done. Here at Individual Dental Insurance we can shop for the best dental coverage that protects us at reasonable prices. Dental expenses like x-rays, orthodontics, oral surgery, are some major considerations when shopping for a good dental program. Individual dental insurance doesn't have to break our bank. Many people make the serious mistake of putting off or utterly ignoring their dental care because they're afraid it will cost too much. However, today there are many affordable dental plans available to suit any budget. Sometimes we have lots of questions in our mind for individual dental insurance, like, what is the best dental solution for our individual needs? Which company will provide us with the best rates and coverage on a dental plan? Should we buy a dental discount card or a full dental KES SHROFF COLLEGE OF ARTS& COMMERCE 12
  • 13. TYBBI SEM-VI DENTAL INSURANCE insurance plan? In this condition, The Dental Club is appropriate solution. Dental clubs are always helpful like, • To give us immediate and predictable discounts without any limits on savings. • The Dental Club can save us money when compared to a typical individual dental insurance plan. The new model for individual dental insurance is "pay as you go" without the usual high prices. For a monthly fee, a person will receive access to a network of reputable dentists who, in turn offer their services at discounted rates. 1) CHILD DENTAL INSURANCE There are a number of different dental insurance programs to choose from, and selecting the Child dental insurance to suit our needs can be challenging. There are discount plans, traditional plans, Dental Health Maintenance Organizations, and sub-categories within this list. How to know where to start? Begin by deciding the type of coverage we need. Child dental insurance is most often an extension of our health insurance plan. Whatever we choose should be compatible with our medical insurance without overlapping the coverage. There is no need to be pay twice for the same thing. On the other hand, make sure that our Child dental coverage provides us with all the features we'll need. Most plans take care of routine visits and KES SHROFF COLLEGE OF ARTS& COMMERCE 13
  • 14. TYBBI SEM-VI DENTAL INSURANCE cleanings, but some are more comprehensive than others. We'll pay more for increased services, but if this is something that we want and will use, the added costs may be well worthwhile. Decide whether we want a deeply discounted plan that will allow us to receive dental services from anyone within that network, or if we are more comfortable visiting our own dentist each time. Discount plans may be a cheaper form of Child dental insurance in some instances, and may make sense for those who travel frequently or need access to a dentist often. Routine visits to the dentist are the most cost effective way to keep dental payments low. Our dentist is then able to do an oral examination and assess any potential problems early enough to correct them. It has been shown that those people who have Child dental insurance go to the dentist more often and have better oral hygiene. Child dental insurance is all about receiving preventive care. In fact, the cost of dental care has continued to fall over the past decades. In 1970, 6.3 percent of total health care costs were devoted to dental care, while in 1991; only 4.9 percent was being spent. As more and more people practice good dental habits, the costs of care decline. The entire focus of Child dental insurance is on preventing dental problems and disease. It requires the patient to take responsibility for their dental practices, such as correct brushing and flossing to maintain healthy gums and good teeth. This type of insurance is designed to cost the patient less to prevent the problem than to fix it, providing some built- in incentive to develop good dental habits. Some don't consider discounted dental plans to be dental insurance, and strictly speaking, they aren't. There are no claim forms or waiting periods, no maximums, no deductibles, and no limits on how often we KES SHROFF COLLEGE OF ARTS& COMMERCE 14
  • 15. TYBBI SEM-VI DENTAL INSURANCE can visit the dentist. The monthly costs are also quite low, in most cases. These plans can also be reasonably flexible as far the dental service provider, allowing us to use any dentist who is part of the program. For many people, then, this is the ideal Child dental insurance. FAMILY DENTAL INSURANCE Family dental insurance is one of the most popular supplemental options for overall medical insurance policies. It's an inexpensive way to provide comprehensive coverage for our entire family. Just having medical coverage isn't enough, especially if we have children. All too often they need orthodontics or have special requirements to ensure that their teeth grow straight and strong. In fact, pediatric dentistry may be an option, even if we are enrolling in a Dental Health Maintenance Organization. It's a good idea to start children off right with an appreciation of their teeth and the tools to take care of them. Most dental disease is preventable, and it requires so little effort to have a clean, healthy mouth. Having family dental insurance is a great way to ensure that everyone's teeth and gums get the attention they deserve. Children also learn by example, and if they see that parents are brushing and flossing regularly, they will want to do the same. Family dental KES SHROFF COLLEGE OF ARTS& COMMERCE 15
  • 16. TYBBI SEM-VI DENTAL INSURANCE insurance shows that we care about the quality of our family's total health care. Supplementing a medical policy will provide overall coverage that otherwise would be excluded. Going to the dentist on a regular basis is more likely if the fees are covered by our insurance plan. Paying for individual family members can get costly, and this can be offset by family dental insurance. Discount plans allow us to get a deeply reduced rate as part of the network. There are a variety of membership plans, but the basic idea is to provide covered services at a reduced rate for anyone who is part of that network. The advantage to this type of family dental insurance is obvious for those who travel frequently. Should an emergency arise in a location far from home, reliable dental services would be available. There is also usually no paperwork to complete, no waiting period, and no deductible to meet. All a member needs to do is present their cards as proof of enrollment, and they are eligible to receive services. With traditional family dental insurance, there will be deductibles to consider, and less overall flexibility in many of the plans. However, the customer can visit their dentist of choice (although some plans also require the dentist to be a member of the network). This insurance tends to pay for the more expensive treatments up to the limits of the plan once any deductible has been met. With lots of choices available, it is important to consider exactly what type of coverage would best suit our family. Take the lead from the type of health insurance we've purchased, if that's a product we've been happy with. For example, if we have and are pleased with a medical Health Maintenance Organization (HMO), a Dental Health Maintenance KES SHROFF COLLEGE OF ARTS& COMMERCE 16
  • 17. TYBBI SEM-VI DENTAL INSURANCE Organization is certainly worth consideration. But if our comfort level runs toward traditional medical insurance or the deeply discounted plans, perhaps our family would be best served with more conventional family dental insurance. CHEAP DENTAL INSURANCE The need for cheap dental insurance: Good oral hygiene is a pre- requisite to maintain a healthy life style, as symptoms of various diseases like diabetes, heart attack, strokes, bone loss, oral cancer etc can be detected by regular dental screenings. The need for cheap dental insurance is growing rapidly as maintaining good dental health is expensive. We can avoid costly dental procedures that result from poor oral hygiene and hence save lot of money in the long run with even a cheap dental insurance. Regular dental cleaning and check up needs to be done at least twice a year. People who are more prone to oral diseases should have cleaning and check up more than twice a year. Cheap dental insurance will be one of the best supplements for a major medical policy. If we already have some type of medical insurance coverage, a cheap dental insurance plan may be all that's needed. But before we buy it, be certain about what we're getting - and that this will meet our needs. It would be unfortunate to buy a dental plan and then, when we need it, learn that the coverage we expected just isn't there. It is important that we read the fine print in our policy document to learn about any limitations and exclusions. KES SHROFF COLLEGE OF ARTS& COMMERCE 17
  • 18. TYBBI SEM-VI DENTAL INSURANCE It is regular medical and dental insurance policy to exclude existing conditions so disclose this to our insurance company before we make our purchase else we will be penalized and may have to pay larger premiums or completely. Discount dental plans, which strictly speaking aren't insurance but take the place of it, have become popular over the past few years, and there are plenty of programs from which to choose that truly offer cheap dental insurance. These plans are membership programs and require using dental services within a network. That network may be large or small, local or national and our choice should be based upon our lifestyle. For someone who doesn't travel beyond his or her state, becoming part of a national network is unnecessary (and possibly more expensive). An advantage to using a discount plan for our cheap dental insurance is that there are no deductibles to meet and no paperwork to fill out. Usually, there is no waiting period. Dental services are discounted for those that are part of the network, and fees are established for each service. Dentists who join as part of the network have agreed to discount their fees and can only charge what has been negotiated under the terms of the policy. There are no surprises when it comes time to pay. We know in advance what the scheduled fees are for each procedure performed. Examine the subtle and not-so-subtle differences to find a cost effective option that meets our budget. Remember, the cheaper the insurance, the less features and flexibility that plan will offer. At the very least, the policy should cover basic preventive care. This means two cleanings and oral examinations a year as well as routine x-rays. It could also include getting teeth filled, or even more extensive dental work. Even with cheap dental insurance, policies will vary in what is offered, so it pays to check KES SHROFF COLLEGE OF ARTS& COMMERCE 18
  • 19. TYBBI SEM-VI DENTAL INSURANCE different types of programs to be certain the one we select suits our situation. Remember, too, that there is a difference between cheap dental insurance and cost-effective dental insurance. Dental insurance becomes cost- effective when we get the type of policy that fits our needs. By getting routine check-ups that prevent potential problems due to neglect; we've saved money in the long run. However, even if we don't pay a lot, if our insurance is ignored (and figures have shown that 40% of dental insurance in the U.S. goes unused) it can be very expensive. MEDICAL AND GROUP DENTAL INSURANCE If we are considering purchasing or already have medical insura nce, a Group Dental Insurance plan should not be far behind. Why? Because medical and Group Dental Insurance go together. They supplement each other and provide comprehensive coverage in case of accident or injury. The good news about dental coverage is that it tends to be quite inexpensive and very cost effective when used. Group Dental Insurance is all about preventing problems that could arise through poor hygiene and sloppy care. Routine visits to the dentist are scheduled to detect most of the diseases and correctible conditions that might occur. Medical insurance is designed to cover diagnosis, treatment, and cure of serious KES SHROFF COLLEGE OF ARTS& COMMERCE 19
  • 20. TYBBI SEM-VI DENTAL INSURANCE illness and similar situations that arise. So with the combination of medical and Group Dental Insurance, there is complete protection. Or is there? That depends upon the type of medical and Group Dental Insurance we choose. Plans range from the most comprehensive to discount fee-for-service. Because there's such a wide range to select from, finding the one that's going to meet our needs may not be as simple as we expect. Whatever we decide to go with, is certain that our medical and Group Dental Insurance plans are compatible. We don't want to be pay for overlapping coverage, but we also don't want gaps in our coverage, either. One should pick up where the other leaves off. We should be able to find medical and Group Dental Insurance plans that are written specifically for our location or state. If not, there are national companies that offer this type of protection. We want to purchase from a company with a solid reputation and that can provide service to our local area. There are national companies that specialize in writing medical and Group Dental Insurance policies for certain states. Frequently, the same company can write both plans. Some offer the service of signing up online. Before doing this, we may want to speak with an actual representative to be sure that we are getting the correct coverage for our situation. Choosing the optimum medical and Group Dental Insurance plan does take some effort and investigation, but remember why we are making that purchase. This is our safety net against catastrophic bills should a medical or dental accident or emergency occur. It is also to prevent conditions that could easily be diagnosed and treated before a major problem develops. KES SHROFF COLLEGE OF ARTS& COMMERCE 20
  • 21. TYBBI SEM-VI DENTAL INSURANCE Everyone in the U.S. needs medical and Group Dental Insurance. It's not an option but a necessity. There are too many times when people are underinsured and realize that in the long run, it would have been far cheaper to have the appropriate medical and Group Dental Insurance. (b) (c) DISCOUNT DENTAL INSURANCE How discount dental insurance is different from traditional dental insurance: discount plans are different from traditional dental insurance in several ways. First, Discount Dental Plans are easy to enroll in by removing the hassles and waiting periods associated with traditional Dental Insurance. Also, unlike traditional Dental Insurance, discount plans do not deny coverage based on patient pre-existing dental conditions. Another nice feature of Discount Dental Plan is there is no complicated claim forms required for usage. In addition, there are no insurance Deductibles or Disputes to worry about. Most importantly, there is no annual maximum benefit – we can use the plan as much and as often as needed. How discount dental plan are similar to dental insurance: The network of providers that participate in the Dental Discount plans are licensed KES SHROFF COLLEGE OF ARTS& COMMERCE 21
  • 22. TYBBI SEM-VI DENTAL INSURANCE professionals just like we would find on most traditional Dental Insurance Plans. Discount Dental Plans are not Dental Insurance. Most “Dental Insurance Plans” are designed for large groups, organization, or businesses. Discount Dental Plans are an innovative alternative to Dental Insurance, designed to suit the needs of individuals and families looking to save money on Dental Care. Typically, Dental Insurance is difficult to obtain unless provided by our workplace or employer. Discount Dental Plans have stepped in to save people money that would not be able to acquire traditional Dental Insurance. KES SHROFF COLLEGE OF ARTS& COMMERCE 22
  • 23. TYBBI SEM-VI DENTAL INSURANCE 5. DIFFERENCE BETWEEN DENTAL PLAN AND DENTAL INSURANCE Dental insurance is simply an agreement between the dental insurance company and us that will allocate us to get pleasure from discounts on dental expenses. Maybe we will think that dental insurance and dental plan are just one and the same, but we are wrong. There is big difference between the two. First let us understand what a dental plan is. A dental plan is simply the agreement between us and the company that will provide the plan for us. Just like dental insurance, it is a plan that will also give us discounts on all our dental costs. They will also let us choose the doctor that we like from the lists and the process of the approval is so easy. One good thing about dental plans is that if we want to decrease our dental costs without filling out so many documents, then this one is the right for us. Are we still a bit confused about the difference between the two? There are more ways wherein a dental plan is dissimilar from dental insurance. • With dental insurance, we need to accomplish tons of application forms, and not only that, because we still need to convince them that we are free from any dental problems in the present that can affect our dental care in the future. Which is exactly opposite if we apply for a dental plan. Worry free when it comes to documents because the process is very simple. • With dental insurance, they may still require us to undergo dental examination in order to qualify and we still have to wait for a long period of time. While in dental plan, we just have to apply and pay a certain amount of money for our membership and that’s it. Once KES SHROFF COLLEGE OF ARTS& COMMERCE 23
  • 24. TYBBI SEM-VI DENTAL INSURANCE they accept our application, we may already enjoy getting discounts on our dental care expenses. • With dental insurance, most of the time procedures that will make our teeth look good is not covered like, teeth whitening, braces and many more. On the other hand, with some dental plans, we may be eligible for treatments of pre-existing situation. Both dental insurance and dental plans cover cleaning of teeth, root canals and other dental care. In getting our claims, there is also a big difference, with dental insurance; first, we have to fill out a form that will be given to the doctor or to the dental insurance company for approval which means that we will wait in order to find out if our money will be reimbursed for the dental expenses. Sometimes dental insurance companies will only give us back a small percentage of the money we incurred for our dental care. While with a dental plan, we will just simply show our membership card and policy number to our dentist and he will be the one who will do all the paperwork for us and we will be able to get the discount immediately. In that way, we just have to pay our lowered dental expenses straight to our dentist. If we have money, buy one that’s worth our money. But unfortunately there are some people who can’t really afford them. We can always find the best and affordable dental insurance for our self. A lot of insurance companies claim that they are the best because they are offering the best dental care package, the best discount dental plans and a lot more. We must be aware that dental insurance can be as intricate as other kind of insurance. We have to be smart in choosing them. KES SHROFF COLLEGE OF ARTS& COMMERCE 24
  • 25. TYBBI SEM-VI DENTAL INSURANCE Dental insurance Quote: Dental insurance quotes are far more reasonably priced than medical, and we all realize that paying for any insurance leaves no possibility for the disasters of not having coverage when the unforeseen occurs. While the costs of dental services are rising, employers are cutting dental benefits out of their employee insurance plans. But it can more frequent access to appropriate care when it is needed. Dental Insurance Quotes: Unfortunately, many people are not aware of all of the options they have when it comes to gaining access to reasonably priced dental care. For those caught in the middle (those who are not covered by an employer's insurance, who cannot afford to pay cash, or who do not have access to whatever public funds are available), there are now dental insurance quotes that can help. Major insurance companies have created dental care networks, some of which are available nationwide. Getting Dental Insurance Quotes: There are many sources through which we can get information on different dental insurance quotes, including individual plan, discount plans, and supplemental dental insurance. Whether we request a quote over the phone, in an office, or on one of the myriad of dental insurance websites, be sure to be informed on exactly what we want from our plan. In this way, our quote will be as accurate as possible, with no surprises in our first bill. One easy way to get information on dental insurance plans and discounts is to get our Dental insurance quote over the internet, from the comfort of our home or office. Simply fill out an electronic form, and the company KES SHROFF COLLEGE OF ARTS& COMMERCE 25
  • 26. TYBBI SEM-VI DENTAL INSURANCE will reply to us with an offer. Since it's this simple to get an dental insurance quote, there's no reason we can't shop around to find the right, affordable, practical plan for us. KES SHROFF COLLEGE OF ARTS& COMMERCE 26
  • 27. TYBBI SEM-VI DENTAL INSURANCE 6. DENTAL INSURANCE PROVIDER For Dental Insurance there is still a network of Dental insurance providers that have agreed to provide dental services to a healthy dental care for people at discounted costs. There are the three top reasons that people are turning away from traditional dental insurance and turning toward dental savings plans, Affordability, convenience and third important one is thousands of high- quality nationwide Dental insurance providers. To achieve the highest quality and most financially responsible dental insurance benefits the dental insurance provider should be reliable. People buy dental insurance for a variety of reasons and a good Dental insurance provider is one who provides following facilities to them. • Dental insurance provider, one who pays For Costly Care, Dental care can be a simple cleaning and x-rays. Or, it can involve costly care from orthodontics to crowns and oral surgery. Dental insurance generally pays all or a percentage of the charges related to our dental care. • Dental insurance provider, one who maintains a Healthy Mouth, Studies show that regular dental check-ups and cleanings help maintain a healthy mouth. That's why most insurance plans pay KES SHROFF COLLEGE OF ARTS& COMMERCE 27
  • 28. TYBBI SEM-VI DENTAL INSURANCE 100% for check-ups every six (6) months. Some will even cover (pay for) a check-up immediately after we are approved for coverage. Dental insurance provider, one who protects our Children, from cavities to braces, younger family members will benefit from regular professional dental care. Dental insurance can be a very affordable way to protect against the cost of regular check-ups. Our plan may even pay for more costly care even braces. KES SHROFF COLLEGE OF ARTS& COMMERCE 28
  • 29. TYBBI SEM-VI DENTAL INSURANCE 7. LIMITATIONS OF DENTAL PLAN Today’s health insurance, including our dental plan, is designed to help to get the care we need at a reasonable cost. Because each person’s oral health is different, costs can vary widely. To control dental treatment costs, most plans will limit the amount of care we can receive in a given year. This is done by placing a dollar “cap” or limit on the amount of benefits we can receive or by restricting the number or type of services that are covered. Some plans may totally exclude certain services or treatment to lower costs. Know specifically what services our plan covers and excludes. There are, however, certain limitations and exclusions in most dental benefits plans that are designed to keep dentistry’s costs from going up without penalizing the patient. All plans exclude experimental procedures and services not performed by or under the supervision of the dentist, but there may be some obvious exclusion. Sometimes dental coverage and health insurance may overlap. Read and understand the conditions of our dental plan. Exclusions in our dental plan may be covered by our medical insurance. The California Dental Association encourages consumers to choose plans that impose dollar or service limitations, rather than those that exclude KES SHROFF COLLEGE OF ARTS& COMMERCE 29
  • 30. TYBBI SEM-VI DENTAL INSURANCE categories of service. By doing so, we can receive the care that’s best for us and actively participate with the dentist in the development of treatment plans that give the most and highest quality care. To help us stretch each dental benefit dollar, most plans provide patients and purchasers with special administrative services. Find out if plan provides the following mechanism to help our budget, analyze, and dispute, if necessary, the costs of our dental care. 1. PREDETERMINATION OF COSTS: Some plans encourage us or our dentists to submit a treatment proposal to the plan administrator before receiving treatment. After review the plan administrator may determine the patient’s eligibility, the eligilibility period, services covered, the patients required co-payment and the maximum limitation. Some plans require predetermination for treatment exceeding a special dollar amount. This process is also known as preauthorization, precertification, pretreatment review or prior authorization. Although our dental benefit plan may not be bound to predetermine costs, this mechanism can help our dentist plan and us and budget a treatment plan appropriates to our oral health needs. 2. ANNUAL BENEFITS LIMITATIONS: To help certain costs, our plan may limit our benefits by number of procedures and / or dollar amount in a given year. In most cases, particularly if we have been getting regular preventive care, these KES SHROFF COLLEGE OF ARTS& COMMERCE 30
  • 31. TYBBI SEM-VI DENTAL INSURANCE limitations allow for adequate coverage. By knowing in advance what and how much our plan allows, we and our dentist can plan treatment that will minimize out – of – pocket expenses while maximizing compensations offered by our benefits plan. 3. PEER REVIEW OF DISPUTE RESOLUTION: Many plans provide a peer review mechanism through which disputes between third parties, patients and dentists can be resolved, eliminating many costly court cases. Peer review is established to ensure fairness, individual case consideration and thorough examination of record, treatment procedures and results. Most disputes can be resolved satisfactorily for all parties. 4. PREMIUM ADJUSTMENTS AND REVALUATION: Patients and plan purchasers should insist on regular reviews of premium levels to ensure that UCR or Table of Allowances payment schedules are equitable. This analysis can help optimize our benefit levels, ensuring that every dollar is spending are used wisely. 5. CORDINATION OF BENEFITS: If we are covered under two dental benefits plans, notify the administrator or carrier of our primary plan about our dual coverage status. Plan benefits coordination can help protect our rights and maximize our entitled benefits. In some case we may be assured full coverage where KES SHROFF COLLEGE OF ARTS& COMMERCE 31
  • 32. TYBBI SEM-VI DENTAL INSURANCE plan benefits overlap, and receive a benefit from one plan where the other plan lists exclusion. 8. OPTIONS IN DENTAL INSURANCE Everyone needs dental care. Unfortunately, not everyone knows there are a variety of ways to pay for a dentist and dental care. There are more choices than just traditional insurance and those choices can save our money on our dental care. If we need a way to pay our dental care and dental fees, here are 4 dental insurance options we may want to consider: 1. TRADITIONAL DENTAL INSURANCE: These are the plans mostly used to work similar to health insurance plans. With traditional dental insurance plans we pay a weekly or monthly premium and receive benefits such as 80 – 100 % of our dental costs covered. We can find traditional dental insurance plans through our employer or an insurance agent. Remember though, if we go to an insurance agent and not to our employer than our cost may be higher. Also, some procedures and prior problems may have awaiting period or may not be covered. Always check with our employer first when looking to purchase a dental plan. KES SHROFF COLLEGE OF ARTS& COMMERCE 32
  • 33. TYBBI SEM-VI DENTAL INSURANCE 2. DENTAL REIMBURESMENT PLAN: A dental reimbursement plan is not insurance but instead a type of agreement between our employer and us. With a dental reimbursement plan we pay for our dental care then take our receipt to our employer and then reimburse us up to a specified limit ( usually $ 500 - $ 1000 per year). This is a great way for an employer to offer benefits to their employees and neither party has to worry about paying monthly premiums to an insurance company or has to worry about having limited choices in a dentist. If we like the idea of having a dental reimbursement plan in our work place just ask our employer. 3. VOLUNTARY GROUP PLANS: Want dental insurance at our work place? Get together with our fellow co-workers and ask our employer to set up a voluntary group dental insurance plan. With this type of plan, our co-workers and we pay all the fees of the dental insurance but it is set-up through our employer so we are able to get a cheaper group rate and possibly better benefits. There is strength in numbers. 4. DENTAL DISCOUNT PLANS: A dental discount plan can be a great way to pay for our dentist and dental care at a lower cost. Dental discount plans are not insurance but instead one would get a specific discount on specific services. For Example: We go to the dentist and the “off the street” fee is $ 100 for a visit and cleaning. With a Dental discount plan, if its discount is 20 % then instead of paying the normal $ 100 visit / cleaning fee we would only pay $ 80 thus getting a 20 % discount on our services. These types of plans usually require us to pay an enrollment fee and a monthly fee to the dental discount plan provided but the fees are less than KES SHROFF COLLEGE OF ARTS& COMMERCE 33
  • 34. TYBBI SEM-VI DENTAL INSURANCE insurance. Also, our dentist choices will be limited to the dentist in our area that accepts the dental insurance plan. 5. WITH ANY DENTAL PLAN CHOICE: Look at all the facts and find what will best fit our needs. For some, a dental discount plan may be the best fit for them since the employer does not offer any type of dental discount plan. And is not willing to negotiate a plan in the work place. But for others, purchasing dental insurance through their employer is best since they have a family to insure and a history of dental problems. And in some instances, we may feel just fine paying for a dental out of pocket and are not interested in paying premiums all the time for dental insurance. Most importantly, what ever we choose we will save more money in the long run by keeping current with dental check ups to prevent any expensive major damage in the future. We need a dentist but don’t have dental insurance? Everyone needs dental care. Unfortunately, not everyone knows there are a variety of ways to pay a dentist and a dental care. There are more choices than just traditional dental insurances and those choices can save our money on our dental care. KES SHROFF COLLEGE OF ARTS& COMMERCE 34
  • 35. TYBBI SEM-VI DENTAL INSURANCE 9. EIGHT THINGS TO CONSIDER WHILE CHOOSING DENTAL PLAN What looks like a bargain today may not be a good buy in the long run? While our out – of – pocket costs are, off course, an important part of our decisions – making process when choosing a dental plan, they are not the only criteria to use when evaluating our options. Our primary focus should be to determine whether the coverage will satisfy our dental care needs. Consider the following: 1. DOES THE PLAN GIVES US FREEDOM TO CHOOSE OUR OWN DENTIST OR WE ARE RESTRICTED TO A PANEL OF DENTISTS SELECTED BY INSURANCE COMPANIES? If we have a family dentist with whom we are satisfied, consider the effects changing dentists will have on the quality or quantity of care we receive. Because regular visits to the dentists reduce the likelihood of developing serious dental disease, it’s best to have and maintain an established relationship with a dentist we trust. KES SHROFF COLLEGE OF ARTS& COMMERCE 35
  • 36. TYBBI SEM-VI DENTAL INSURANCE 2. WHO CONTROLS TREATMENT DECISIONS – WE AND OUR DENTISTS OR THE DENTAL PLAN? Many plans require dentists to follow treatment plans that rely on a Least Expensive Alternative Treatment (LEAT) approach. If there are multiple treatment options for a specific condition, the plan will pay for the less expensive treatment option. If we choose a treatment option that may better suit our individual needs and our long-term oral health, we will be responsible for paying the difference in costs. It’s important to know who makes the treatment decisions under our plan. These costs control measures may have an impact on the quality of care we’ll receive. 3. DOES THE PLAN COVER DIAGNOSTIC, PREVENTIVE AND EMERGENCY SERVICE? IF SO, TO WHAT EXTENT? Most dental plans coverage for selected diagnostic services, preventive care and emergency treatment that are basic for maintaining good oral health. But the extent or frequency of the services covered by some plans may be limited. Depending upon our individual oral health needs, we may be required to pay the dentist directly for a portion of this basic care. Find out how much treatment is allowed in any given year without cost to us, and how much we will have to pay for our self. Every dental care plan is different. It’s our responsibility to be informed about what our specific plan will cover. As a basis of comparison, the following services should be covered in full, with no deductible or patient co-payment: Initial Oral Examination – once per dentist Recall Examinations – twice per year KES SHROFF COLLEGE OF ARTS& COMMERCE 36
  • 37. TYBBI SEM-VI DENTAL INSURANCE Complete x – ray survey – once every three years Cavity – detecting bite – wing X ray – once per year Prophylaxis or teeth cleaning – twice per year Topical Fluoride treatment – twice per year Sealants – for those under age 18 4. WHAT ROUTINE TREATMENT IS COVERED BY THE DENTAL PLAN? WHAT SHARE OF THE COST WILL BE OURS? While preventive care lessens the risk of serious dental disease, additional treatment may be required to ensure optimal health. A broad range of treatment can be defined as routine. Most plans cover 70 percent to 80 percent of such treatment. Patients are responsible for the remaining costs. Examples of routine care include: Restorative care – amalgam and composite resin filling and stainless steel crowns on primary teeth Endodontics – treatment of root canals and removal of tooth nerves Oral Surgery – tooth removal (not including bony impaction) and minor surgical procedures such as tissue biopsy and drainage of minor oral infections. Periodontics – treatment of uncomplicated periodontal disease including scaling, root planning and management of acute infections or lesions. KES SHROFF COLLEGE OF ARTS& COMMERCE 37
  • 38. TYBBI SEM-VI DENTAL INSURANCE Prosthodontics – repair and / or reseating of existing dentures and bridges. Understand what routine dental care by the plan, and what percentage of the costs will come out of our pocket. 5. WHAT MAJOR DENTAL TREATMENT IS COVERED BY THE PLAN? WHAT PERCENTAGE OF THESE COSTS WILL BE REQUIRED TO BE PAID BY US? Since dental benefits encourage us to get preventive care, which often eliminates the need for major dental work, most plans are not generous when it comes to paying for major dental work, most plans cover less than 50 percent of the cost of major treatment. Most plans limit the benefits -- both in number of procedures and dollar amount – that are covered in a given year. Be aware these restrictions when choosing our plan and as our dentist and we develop treatment best suited for us. Major dental care includes: Restorative care – gold restorations and individual crowns Oral Surgery – removal of impact teeth and complex oral surgery procedures Periodontics – treatment of complicated periodontal disease requiring surgery-involving bones, underlying tissues or bone grafts. Orthodontics – treatment including retainers, braces and / or diagnostics materials. Dental Implants – either surgical placement or restoration KES SHROFF COLLEGE OF ARTS& COMMERCE 38
  • 39. TYBBI SEM-VI DENTAL INSURANCE Prosthodontics – fixed bridges, partial dentures and removable or fixed dentures. 6. WILL THE PLAN ALLOW REFFERAL TO SPECIALISTS? WILL MY DENTIST AND I BE ABLE TO CHOOSE THE SPECIALIST? Some plans limits referrals to specialists. Our dentist may be required to refer us to a limited selection of specialists who have contracted with the plans third party. We also may be required to get permission from the plan administrator before being referred to a specialist. If we choose a plan with these limitations, make sure qualified specialists are available in our area. Look for a plan with a broad selection of different of specialist. If we have children we may prefer a plan that allows a pediatric dentist to be our Childs primary care dentists. Since specialize treatment is generally more costly than routine care, some plans discourage the use of specialist. While many general practitioners are qualified to perform some specialized services, complex procedures often requires the skills of a dentist with special training. Discuss the option with our dentist before deciding who is best qualified to deliver treatment. 7. CAN WE SEE THE DENTIST WHEN WE NEED TO? AND SCHEDULE AN APPOINTMENT TIME CONVINIENT TO US? KES SHROFF COLLEGE OF ARTS& COMMERCE 39
  • 40. TYBBI SEM-VI DENTAL INSURANCE Dentist participating in closed panel or capitation may have selected hours to see plan patients. They may schedule appointments for these patients on these given days, or at specific hours of the day, restricting our access. Some dentist’s fee for seeing us on weekends or emergency are high than those the plan allows. We may be required to pay the additional costs our self. If we select these types of plans, have a clear understanding of our dentist’s policies as well as the plans dentists – to – patient ratio. It’s the best way to ensure our access to care is not unduly restricted and that higher fees the plan does not cover do not surprise us. 8. WILL THE PLAN PROVIDE BENEFITS TO PATIENTS WHO MAY ALSO BE COVERED BY OTHER DENTAL PLANS? It is not unusual to be eligible for dual benefits. We may be covered under our companies plan as well as under that of our spouse’s employer. In analyzing our options, make sure to look for a plan that allows coordination of benefits We should be entitled to either 100 % coverage or some form of premium credit. By coordinating benefits, we can eliminate being penalized or denied coverage when the two plans have conflicting exclusions. Choosing between dental insurance and discount dental plans can seem confusing. However, when properly informed this decision can be easier than we think. Finding which dental insurance plans or discount dental plans are available, or right for us, can become a tedious task. TDIG has brought together leading dental health organizations offering and discount dental insurance. TDIG has taken the guess workout of choosing our dental provider. We have compared these services to assist us in deciding which best suits our needs. KES SHROFF COLLEGE OF ARTS& COMMERCE 40
  • 41. TYBBI SEM-VI DENTAL INSURANCE 10. SURVEY REPORT Analysis of the Survey to find out the perception about Dental Insurance in India Q.1) Do you have Insurance? This question helped us to find out the actual involvement of our sample in insurance and as expected the result turned out to be quiet low, only 40% of the sample is insured. Still if we compare this percentage with national figures it’s quite good. Q.2) How much does it cost? KES SHROFF COLLEGE OF ARTS& COMMERCE 41
  • 42. TYBBI SEM-VI DENTAL INSURANCE This question helped us to find out the amount people spend on Dental Problems. And the results showed that 40% of the people spend till Rs.1000 at Dental Clinic and majority of them spends till Rs.2000. This shows that people spend a big amount for their Dental Care. Q.3) Are you aware about Dental Insurance? This question was asked to find out the awareness about Dental insurance, which is a new concept in India. The result showed that around 60% of the people are aware about Dental Insurance. Q.4) Do you think Dental Insurance can cover that cost? KES SHROFF COLLEGE OF ARTS& COMMERCE 42
  • 43. TYBBI SEM-VI DENTAL INSURANCE As we got to know from previous questions that people spend a good amount on Dental Care and they also are aware about Dental Insurance which prompted us to ask them that do they think the Dental Care fees can be covered through Dental Insurance. The result showed that around 80% of the people are aware about the benefits of Dental Insurance. Q.5) Do you know that it has not yet introduced in India? This question was asked to find out the awareness of the people about the introduction of Dental insurance in India. The result showed that around KES SHROFF COLLEGE OF ARTS& COMMERCE 43
  • 44. TYBBI SEM-VI DENTAL INSURANCE 70% of the people were aware about unavailability of Dental Insurance in the country Q.6) Do you think it should be introduced in India? This question was asked to find out the acceptance of Dental Insurance as a concept in the country. The result showed that around 95% of the people want Dental Insurance to be introduced in the country. (i) (ii) Conclusion on survey conducted KES SHROFF COLLEGE OF ARTS& COMMERCE 44
  • 45. TYBBI SEM-VI DENTAL INSURANCE From the survey, it is observed that insurance in India is still at its developing stage. Many of them are uninsured. Some are facing with dental problems and are paying lump sum amount on it. Very few are aware about of dental insurance. It concludes that dental insurance is not flourishing well in India. It is a new concept in India. But introduction of dental insurance would lead to growth in the Indian economy. 11. CASE STUDY METLIFE-ABOUT CHOOSING A DENTIST Selecting a dentist who meets our needs and expectations is a decision that’s too important to make without investing our time and effort. When we need a dentist, we want a professional we can trust. Don’t select a dentist on the basis of cost or advertising alone. Though daily brushing and flossing makes a difference, seeing a dentist regularly is essential to keep our teeth, gums and mouth healthy. Through regular visits and cleaning, our dentist can detect and remedy potential problems, offering care that ensures a lifetime of good oral health. If we don’t have a dentist, wait until a problem forces us to find one.  WHERE TO START FROM? KES SHROFF COLLEGE OF ARTS& COMMERCE 45
  • 46. TYBBI SEM-VI DENTAL INSURANCE Different types of dentists perform different types of services. Determining which is right for us depends on our dental needs. Do we need a routine cleaning? Do we require dentures? Could our child need braces? Dentists are grouped into two categories: general dentists and specialists. Both general and specialty dentists are well qualified. They have received a four-year doctorate degree in dentistry, which is referred to as either a D.D.S. (doctor of dental surgery) or D.M.D. (doctor of dental medicines), depending upon which college awards it. They also pass state and national board examinations. Specialists, however, differ from general dentists because they have undergone extra training in a particular area of dentistry and limit their practice to that area. (b) GENERAL DENTISTRY General dentists, also known as family dentists, are trained to provide most dental procedures for patients. A general dentist’s service may include: • Routine checkups • X – rays • Teeth cleanings • Fillings • Gum disease screening and treatment • Extractions • Crowns and bridges • Cosmetic dentistry • Root canal therapy • Sealants • Pediatrics dentistry KES SHROFF COLLEGE OF ARTS& COMMERCE 46
  • 47. TYBBI SEM-VI DENTAL INSURANCE • Tobacco cessation • Homecare instructions • Dentures and partial dentures • Mouth guards After our dentist has determined our oral health status and our likely risk of future disease, we should visit our dentist as often as he or she recommends. Regular visits enable our dentist to become familiar with our dental and medical history and to coordinate our dental care. This practice can help prevent dental disease before it requires involved care, such as a root canal or periodontal (gum) surgery. If our general dentist determines us that we have a problem requiring special skills, knowledge or equipment, he or she will refer to a specialist. Our general dentist will explain to us why the referral is recommended, and an appointment may be scheduled before we leave. He or she should share our dental records, X-rays and any relevant dental and general health information with specialty dentist. (c) SPECIALTY DENTISTRY A specialty dentist typically has completed two to six years of education in a specific area of dentistry. After a dentist has successfully completed additional programs and trainings, he or she may elect to take a specialty examination. Some specialists we may be referred to during the course of our dental treatment include: • Endodonist Endodonists care for the inner portion of the teeth. They perform canals and treat diseases of the pulp and nerves inside the tooth. KES SHROFF COLLEGE OF ARTS& COMMERCE 47
  • 48. TYBBI SEM-VI DENTAL INSURANCE • Oral Pathologist Oral and Maxillofacial Surgeon Oral and Maxillofacial surgeons treats injuries and defects of the mouth and jaw; they also often perform complex tooth extractions. Oral pathologists examine, identify, diagnose and treat diseases of the mouth. • Orthodontist Orthodontist design and apply corrective and supportive appliances (braces) to realign crooked teeth. • Pediatric dentists Pediatrics dentists are for infants, children, adolescents and special patients having psychological, physical or emotional problems. These practitioners are skilled at handling the first visits to the dentist. • Periodontist Periodontists treat diseases of the soft tissues (gums) and bone that surround and support the teeth. • Prosthodontist Prosthodentists design, construct and fit replacement teeth, such as implants, bridgework and dentures.  NARROWING CHOICE If we don’t have a general or family dentist, now’s the time to select one. If we have dental insurance, check to see if our dental plan requires us to choose from a list of dentists who participate in the plan. Some insurance plans allow us to choose an out-of-network dentist (one who does not participate with the plan). Generally, our benefit will be less. KES SHROFF COLLEGE OF ARTS& COMMERCE 48
  • 49. TYBBI SEM-VI DENTAL INSURANCE Ask friends, relatives and coworkers for personal recommendations. Inquire what dentists they see and whether they are satisfied with the dentist’s service and quality of care. Ask our family physicians, pharmacist and faculty members of a local dental school if they can provide suggestions. Or contact the local or state dental society for referrals. (They’re usually listed in telephone directories under “dentists” or “associations.”) If we’re moving, our current dentist may be able to make recommendation. We also can check with a dental network or referral services. These groups prescreen participants, generally recording dentists’ educational background, experience and specialty, as well as other information, such as their ability to speak a second language. Be aware, however, some services only list dentists who pay to be included. To learn about a dentist’s credentials, we can check the American Dental Directory at our local library. Another consideration is the location of a dentist’s office. Ideally, we’ll want it to be convenient to where we live or work. Find out, too, about office hours. If needed, are evening or weekend appointments available? Once we’ve narrowed our list to two or three dentists call their offices to ask preliminary questions, such as: • Does the practice accept our dental plan? • Is payment requested at the visit or will the dentist file our insurance company claim and bill we for the balance? • Is the dentist willing to set up a payment plan for more comprehensive treatments? Are there various payment plans offered? KES SHROFF COLLEGE OF ARTS& COMMERCE 49
  • 50. TYBBI SEM-VI DENTAL INSURANCE • Does the dental staff use universal precautions for infection control, such as gloves, masks, protective clothing and sterilized instruments and work areas? • What is the protocol for patients who have emergencies during office hours, after office hours and when the dentist is away? • Are patients notified when it’s time for a checkup? Are all patients recalled every six months or is the recall level adjusted for individual needs? • Does the dentist treat children?  PERSONAL EVALUATION Because a trusting relationship between our dentist and us is so important, we may wish to reserve time to ask question during the initial examination. • Will the dentist develop a treatment plan for us and discuss it with us on a regular basis? Will the dentist provide treatment options? • If needed, does the dentist utilize sedation, such as nitrous oxide? • Does the dentist take and keep our medical and dental history on file? How often does the dentist update our medical and dental history? • How are patients screened for periodontal disease? • If we call the practice with a problem, will our call be put through to the dentist? Are there established times for call to and from the dentist? Are telephone calls returned the same day? • Does the dentist take continuing education classes? • Ask the dentist to explain anything we don’t understand. If we’re dissatisfied with his or her answers, or uncomfortable with the KES SHROFF COLLEGE OF ARTS& COMMERCE 50
  • 51. TYBBI SEM-VI DENTAL INSURANCE dentist’s manner, consider using another dentist from our list. Remember, we should feel content with our decision. While on our visit, make observations about the office. • Is the office clean, neat and professional? • Is the staff friendly, helpful and professional in manner and dress? • Are patients seen promptly? • Is the practice a high-volume operation in which the dentist rushes from patient to patient? These dentists may be unwilling or unable to spend extra time with us if we need it. Once we’ve made our selection and scheduled a visit, be sure to inform the practice about our dental benefit plan. If our dental benefit plan uses a special claim form, bring one with the patient / employee portion completed. KES SHROFF COLLEGE OF ARTS& COMMERCE 51
  • 52. TYBBI SEM-VI DENTAL INSURANCE 12. CONCLUSION Dental insurance has a lot of importance in today’s world. It gives us an idea to protect the mouth set and also encourages savings. Dental insurance is well flourish all over the world. But it has not yet introduced in India. Everyone needs dental care .Taking care of teeth is not so affordable in today’s modern world. Dental insurance provide different plans for different needs. Dental insurance is equally important to a human being as health insurance, as dental diseases is so common, being protected by dental insurance and using it wisely are essential safeguards to any individual or a family. Insurance in India is still at its developing stage. Dental insurance is a new concept all together. Dental insurance has a good scope in India in near future. It should be encouraged to facilitate development by providing dental services and savings to individual which in turn leads to overall growth in the Indian economy. KES SHROFF COLLEGE OF ARTS& COMMERCE 52
  • 53. TYBBI SEM-VI DENTAL INSURANCE 13. BIBLIOGRAPHY WEBSITES www.dentalplans.com www.dentalinsurance.com www.individualdentalinsurance.com www.metlife.com www.dentaldiscountplan.com www.123-dental-medical-insurance.com www.dentalcare-indiatour.com SEARCH ENGINES www.yahoo.com www.google.com KES SHROFF COLLEGE OF ARTS& COMMERCE 53
  • 54. TYBBI SEM-VI DENTAL INSURANCE KES SHROFF COLLEGE OF ARTS& COMMERCE 54