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Group Benefits:
Group Dental & Vision Insurance

A great option now are combined Dental/Vision plans.


Vision

Vision policies may be as a rider to a medical policy (but with separate benefits and limits) or as a more comprehensive stand-alone plan.

 

While disease or injury to the eye  typically is a covered expense in most health insurance plans, they do not cover expenses related to periodic eye examinations, glasses or contact lenses, unless through a rider.  Riders (benefits added to another plan sometimes for an additional cost), may cover a vision exam once every 6 months, with the insured paying only a small copay, such as $10, after which needed frames and contacts are offered at a discounted price.

 

Stand alone Vision plans more often include small copays for exams, replacement of lenses, frames and contacts, each over a specified period of time and up to a specified limit of expense. The premium for vision plans is determined by these specific details. Vision plans are highly valued by employees, not very expensive and thus considered a good use of premium dollars. 

 

Dental

There are three major types of dental plans: Traditional Indemnity, PPO (Preferred Provider Organization) and DMO (Dental Maintenance Organization) - also referred to as discount dental plans.

  • Traditional Indemnity - The insurance company will honor claims from any dentist but have maximum fee schedules they will honor for each dental procedural code. Typical plan benefits are:  100% Preventive care (check-up exam and cleaning), 80% of covered charges for Basic procedures (such as fillings), 50% for Major procedures (such a crowns or bridges). A deductible, such as $50 is usually required met before eligible benefits are paid but may not apply to Preventive care.
  • PPO Dental Plans - The insurance company contracts with dentist to charge discounted prices in exchange for members using their services. You receive greater benefits or reimbursements under the plan when using a participating PPO dentist (In-Network), than when using a non-participating provider (Out-of-Network). Example: In-Network Preventive care is covered at 100% and Out-of-Network at 80% of an allowable fee schedule.
  • DMO (or discount dental) - Insurance companies contract with dentist to accept deep discounts in exchange for plan members only receiving benefits payable for services provided by DMO providers. Typically members must sign up and use one dentist. A permanent change of dental providers is allowed, with proper notice. Preventive care benefits are typically at 100% benefit, while other services are provided at a discount or at a specified fee schedule maximum.

 

 


Frequently Asked Questions :: Glossary of Common Terms

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