Dental Insurance Plans
Employers sponsor dental plans for a variety of reasons such as promotion of good health, keeping their work force healthy and fit, and attracting and retaining top-notch employees.
Your employer will provide you with details of your plan that are easy to understand. You should receive a brief overview of the services that are covered, limitations and exclusions, and the fee guide used to calculate benefits. Keep in mind that the actual specifics of the plan will be spelled out in a contract between the employer and the dental plan administrator.
The employer enters into a dental plan contract with a third party that will act as the plan administrator. Dental plan contracts are lengthy, complex documents that define what services are covered and under what circumstances those services are eligible for reimbursement. Some limitations are easily understood, such as frequency limitations. For example, “This service is covered once every three years.” Others are more complex, such as, “This service is covered only when there is evidence of recurrent decay of fracture.”
Dental plan administrators are contractually obligated to reimburse patients based upon the terms of the dental plan contract. This means that in some instances, necessary treatment may not be covered.