August 2002: Dental Provisions #19

Consultant's Corner

Dental insurance vs. coverage
In many ways, the term dental "insurance" is a misnomer. Insurance, by definition, is a contract that compensates for future, specified losses. Insurance is purchased to protect against risk; it's not a prepayment against reality. Dental contracts are designed to cover preventive services, not just losses. Dental coverage is typically provided by an employer to provide financial assistance for routine dental services. The employer usually buys the coverage based on the amount of the benefit and how much the rate is per month.

Most benefit plans are designed to cover only a portion of the total cost of treatment with specific criteria placed on the funds available for payment. For example, the dental contract will cover the cost of a crown only once every seven years, regardless of the reason for replacement. This is not a statement that crowns last only seven years or that crowns must be replaced every seven years. Instead, this is simply a contract limitation. If a crown needs to be replaced before the seventh year, the dental contract will not provide coverage, and the patient is responsible for the full charge.

If you have questions about dental coverage, how it works and/or the impact to the patient, please contact your dental relations representative.

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