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Oral and vision health are more important than just a smile and a nice pair of glasses. Routine dental and eye exams can also help prevent illnesses and conditions before you even realize there is something wrong. Protect your employees with an additional plan.
Professional dental care can diagnose or help prevent common dental problems including toothache, inflamed gums, tooth decay, bad breath and dry mouth. If conditions like these remain untreated, they can worsen into painful and expensive problems such as gum disease or even tooth loss. According to the American Dental Association, more than 16 million children in the United States suffer from untreated tooth decay, which is the most common chronic childhood disease. Regular dental exams can not only treat dental problems but can also identify other serious health concerns, including some types of cancer. Dental coverage will allow you to inexpensively receive preventive and diagnostic care.
Dental coverage focuses on preventive and diagnostic procedures in an effort to avoid more expensive services associated with dental disease and surgery. The type of service or procedure received determines the amount of coverage for each visit. Each type of service fits into a class of services according to complexity and cost. Services are generally broken up into the following classes:
Because dental coverage typically focuses on preventive care, Class I services are covered at the highest percentage. Class II services are then covered at a slightly lower percentage, followed by Class Ill services, which are covered at the lowest level. For example, if a plan follows an “100- 80-50” structure, Class I services are covered at 100 percent, Class II at 80 percent and Class Ill at 50 percent.
Class IV services are frequently covered under a separate lifetime maximum (instead of the annual maximum) and often limit coverage to children under the age of 19.
In addition to the class of service, coverage also depends on other factors. Several common services are limited by frequency. For example, most plans will only cover two cleanings and exams per year. For more complicated procedures or surgeries, coverage is often limited to a maximum dollar amount, such as $1,500 per year. Age is yet another factor that determines coverage. For example, fluoride treatments are typically covered for children, but not adults. Cosmetic procedures, such as teethwhitening, are rarely covered.
Under the Affordable Care Act (ACA), dental services are an essential health benefit for children under the age of 19, although individual states can choose to extend the age limit beyond this baseline. Declaring pediatric dental care an essential health benefit means that, beginning in 2014, all non-grandfathered medical health plans must offer dental benefits for children unless certified stand-alone coverage is available. Non-medically necessary orthodontia is not included in the essential health benefits definition.
The essential health benefit status for dental coverage does not apply to adults. In addition, unlike medical insurance, you do not have to obtain dental coverage to avoid penalties.
Vision insurance generally covers the following services: