Group Dental & Vision Insurance

Group Dental & Vision Insurance:  Employer Sponsored Coverage


What Is Dental Insurance?

Dental insurance is insurance that provides coverage for services relating to the care and treatment of your teeth and gums. Typically, it provides coverage for some or all of the following dental services:

  • Diagnostic procedures
  • Semiannual checkups (including cleanings) and periodic X rays
  • Procedures that restore teeth
  • Oral and maxillofacial surgery (teeth extraction and oral surgery)
  • Periodontics (treatment of bone and gum diseases)
  • Prosthodontics (fillings, dentures, bridges, and crowns)
  • Orthodontics (repositioning of the teeth)
  • Oral surgery
  • Root canal therapy

What Does It Cost?

Dental insurance is typically inexpensive. The annual cost is often less than you spend eating at fast-food restaurants over the course of a year. If you have employer-sponsored dental insurance, the cost to you will be even less because your employer probably pays all or part of the premium.

How Does It Work?

Dental insurance may provide direct payment to the dentist for the dental care and treatment that you receive. Or, you may be required to cover your dental expenses out of pocket at the time of service and then file a claim for reimbursement. It depends on the specific plan. The dental plan may also have a list of preapproved dentists, like a health maintenance organization.

With group dental insurance, deductible and co-payment features usually come into play, though the deductible may not apply to routine cleaning and oral examinations. In addition, you may have to pay a separate coinsurance percentage for orthodontia and certain other procedures. Most plans also place a limit on the total amount of dental benefits that you can receive each year. Finally, if you've just enrolled in a dental plan, be aware that there may be a waiting period before your coverage kicks in.

Where Do You Get It?

Dental insurance has become more common in recent years. Of the roughly 55 percent of Americans who have dental insurance, most receive their coverage through their employer. Employer-sponsored dental insurance may take the form of a health insurance plan that includes dental coverage or a separate dental plan. It could also be benefit choices under a cafeteria plan. Health insurance plans are usually limited to routine cleaning and oral examinations. Separate dental plans usually cover additional dental procedures but place restrictions on amount and price of dental benefits for specific dental treatments.

Unfortunately, if you don't have access to employer-sponsored coverage, you will have a difficult time finding dental insurance. Despite the variety of dental plans available, plans for individuals are rare. Typically, an individual plan will not cover any orthodontia (braces). And dental coverage is seldom found in individual health insurance policies, except maybe coverage for accidental dental injuries.

This doesn't mean that you're out of luck if you're looking for individual coverage, but it does mean that your options may be limited. In fact, one of the few types of plans that's readily available to individuals is what's known as a dental discount plan, which isn't even a true insurance policy.

Who Should Have Dental Insurance And Who Shouldn't?

If your employer offers dental insurance, you should probably enroll in the plan because the benefits usually outweigh the cost to you. If coverage is not available through your employer, you should weigh your options carefully.

As mentioned, individual dental insurance is usually inexpensive but difficult to find. And there's no reason to throw even a little money away on insurance that you don't really need. Why pay monthly premiums, deductibles, co-payments, and so on if you have healthy teeth and rarely go to the dentist except for a yearly cleaning? If this is your situation, it's generally more cost effective to pay as you go for your dental expenses (referred to as self-insuring).

On the other hand, buying your own dental insurance might be a good idea if you've had a history of dental problems and expect to have more, if you smoke (which can cause yellowing and/or decay), or if you're over 40 (age-related decay). If any of these describes you, consider seeking out individual dental coverage.

What Is Vision Care Insurance?

Vision care insurance is insurance that provides coverage for services relating to the care and treatment of the eyes. It typically covers services delivered by an optometrist or ophthalmologist. Depending on the specific plan, some or all of the following services may be covered:

  • Yearly eye exams
  • Glasses (with an annual limit)
  • Contact lenses and fitting (with an annual limit)
  • Glaucoma screening

Some vision plans may provide more extensive coverage (e.g., certain eye surgeries), while others may limit coverage to "reasonable and customary" charges incurred during routine eye exams. Reasonable and customary charges generally don't include the cost of glasses and contact lenses. With some employer-sponsored vision plans, coverage may be even more narrowly limited to the medical treatment of certain eye conditions. This is rare, however.

How much does it cost?

Vision care insurance is generally available for a small, nominal annual premium, often as little as $50 a year. What's more, your out-of-pocket cost may be even less if your employer pays all or part of the premium (as many employers do).

How does it work?

Vision care insurance may provide direct payment to the eye care provider for the services you receive. Or, you may be required to cover the charges out of pocket at the time of service and then file a claim for reimbursement. It depends on the specific plan.

Where do you get it?

Almost everyone who has vision care insurance gets their coverage through work. Employer-sponsored vision care plans may be self-funded or self-administered plans. Vision care insurance may also be part of your employer's group health insurance plan, or one of several options you can choose under your employer's cafeteria benefit plan. Commonly, an employer will purchase a group vision care insurance plan through a health maintenance organization, insurance company, or other organization that offers such plans.

Individual vision care policies are not typically available because they're generally not cost effective from an insurer's standpoint. If you don't have access to vision care insurance through your employer, you may have a difficult time obtaining this kind of insurance through a private, stand-alone policy. Some individual health insurance policies may include vision care coverage, however, or allow you to add it for a slightly higher premium.

Who should have it?

Anyone who has access to employer-sponsored vision care insurance should take advantage of it, because the benefits outweigh the minimal cost. If you don't have coverage and have no vision problems, you should probably just go without vision care insurance and "pay as you go" for annual eye exams. However, if your vision expenses are relatively high (e.g., glasses, contacts) and you don't have employer coverage, you may want to look into other ways of obtaining vision care insurance.