Dental Insurance

Dental Insurance

Dental insurance in Canada usually falls under a health insurance policy or can be purchased as a standalone policy or through employee group plans.

Dental insurance companies reimburse or directly pay for eligible expenses based on a schedule formally submitted by the Dental association of each province.  The schedule outlines the eligible expenses, deductibles, maximum benefit level, and coinsurance.

Waiting Period

The dental insurance waiting period is a period that needs to elapse before the insured can use 100 % of their benefits.   The details of coverage offered during the waiting period and after the waiting period are usually outlined in the insurance contract for the insured.

Why is there a waiting period for dental insurance?

The logic is that dental care providers do not want people to amass a series of dental procedures that need immediate attention and then lapse the policy.  The claims ratio would not be a viable business model for the insurance company as they would stand to lose a lot of money.

Dental Insurance Plans

There are a variety of ways to pay for dental care insurance.

Some of the following ways to get dental care insurance:

1. Traditional Dental Insurance
2. Dental reimbursement plan
3. Voluntary group plans
4. Dental discount plans

Dental Only Insurance Canada

Dental only insurance plans are rare to find, if not impossible. Dental insurance is almost always bundled with another health care benefit. The reason a standalone dental insurance plan does not come exclusively stems from the insurance company’s exposure to people who might claim only once and then lapse the policy!

What Dental is covered by OHIP?

OHIP, of the Ontario Health Insurance Plan, typically does not cover dental care or treatment.  However, OHIP will cover some dental surgeries that need to be performed in a hospital due to greater complexity or if combined with other conditions.

OHIP covers dental surgeries performed at the hospital that include:

• Fracture repair
• Tumour removal
• Reconstructive surgeries
• Medically necessary tooth extraction, subject to OHIP’s prior approval

How much does it cost to get dental insurance?

The cost of dental insurance varies by the type of dental coverage purchased, the limitations and restrictions, and by the deductibles or co-pay, specific to that dental plan.

According to research done by Monster.ca, the average cost of dental insurance is as follows:

• $47 for an individual male
• $80 for an individual female
• $78 for a Male Single Parent
• $110 for a Female Single Parent
• $157 for a Family

What is the best dental coverage?

Trying to decide what dental coverage is best is an exercise in choosing dental coverage that’s best for you or your family.  Everyone has different needs and requirements regarding their dental/oral hygiene, however, there are some key indicators of a good dental insurance policy.

Price – the cost of dental insurance seems to be the primary motivator for many people

Coverage – dental coverage is the gist of any dental insurance policy and should reflect the needs of your dental care requirements

Flexibility – the ability to choose dental coverages that are suitable for

Payment Plan – the ability to pay dental insurance as a monthly installment tends to be the most popular and used dental insurance plan.

Alternate Dental Plans – if you are covered under more than one dental insurance policy will affect your decision to buy extra dental insurance if needed. This can also deter you from making unnecessary purchases as dental insurance is subject to the priority of payment.  Having more than one dental plan might mean that all dental insurance policies would share in the payout of the claim.

Monetary Limitations – the amount of dental insurance required will also be a strong consideration in determining what dental insurance plan is best for you or your family.

Deductibles – the deductible amount on your dental insurance is usually an annual fixed amount that must be paid before any dental care service begins.

Copay – the term copay means that a fixed ratio or amount must be shared by you, every time that dental service is used. An example would be having a 50% copay for Orthodontic services. This means that every time an orthodontic service is completed you’d be responsible for 50% of that cost.

Copay can be tied to any dental service under your plan, so choosing a dental insurance plan with lesser copay, or no copay at all, are usually associated with better dental insurance plans, although the price could be a lot higher!

What does Dental Insurance Cover?

Dental insurance coverage can vary depending on the dental plan, the insurance company provider and the specific policy wordings of the dental insurance contract. Moreover, a dental insurance plan can have different copay and deductible amounts that would affect the cost.

Dental insurance is usually categorized into three or more categories ranging from basic dental services such as regular visits or cleanings to major dental work like porcelain crowns or bridges.

Typically, dental insurance is based on 100%, 80%, and 50 coverage.  This means that most dental insurance plans do not cover the full cost of procedures. In addition to the differences in dental coverage that each plan offers, different percentage of copays exists for certain dental coverages.

Dental insurance covers the following:

Basic Dental Coverage:  this includes cleanings, X-rays, diagnostics and preventative care, fluoride application, scaling, tooth extractions, fillings, oral hygiene and some endodontic and periodontics services.

Major Dental Coverage:  this includes major restorative services such as dentures, crowns, inlays, and bridgework.

Orthodontic Services:  includes orthodontic services for procedures and appliances such as braces, wires, teeth spacers and other aids to help straighten teeth and other defects.

Understanding Dental Insurance Billing

Dental insurance coverage is made on reimbursement or direct billing basis, depending on the dental service provider.

Dental billing on a reimbursement basis means that you would need to pay the invoice for the dental treatment first, and then the insurance company will reimburse you, usually by cheque or direct deposit.  This method of dental billing is the least preferred because it requires using your own money, plus the delay in having that money returned to you.

Direct bill dental plans maybe the most sought after dental plans, simply because of the convenience of not having to fork over your own money and also the time delay before you get the money reimbursed by the insurance company.  Direct billing dental plans also allow for dental treatment that might not be affordable, regardless of their plan was on a reimbursement basis. Some people don’t have the money required to even be in a position to be reimbursed! Dental procedures and services can be very expensive at times and to know that you have direct billing insurance brings greater peace of mind!

Dental Predetermination of Costs

Dental predetermination cost is a way to help policyholders, insurance companies and health care providers ascertain, in advance of any dental procedures or services, the cost of the procedure or service, the amount of dental insurance coverage applicable to that specific dental service or procedure, and how much money the policyholder would need to pay.   Essentially, it’s a way to help the policyholder know what the insurance company will pay or cover, in advance, so that there are no surprises when the invoice is tendered.

Does Health Insurance Cover Dental?

Health insurance can cover dental care depending on the type and scope of health insurance policies. Many health insurance companies add dental care as part of a comprehensive health care product.

Peter Martire, CIP, CRM