Keeping your eyesight sound and your teeth in good shape is not an optional endeavor, but a critical piece of staying healthy for life.
Despite that, many people let these health services languish, figuring they’ll get to them later, when there’s more time or money – especially if their companies don’t offer this type of insurance.
That, needless to say, is not a good strategy, and is likelier to cost more later than regular care. Eye surgeries and extreme dental procedures can run in the thousands to tens of thousands of dollars, and that’s sometimes with insurance.
The bottom line? Insurance is critical. Not only does it provide a major safety net down the road, if one needs such a procedure, it can help you and your employees get the preventative care you need now to avoid serious issues later.
But just how do these types of insurance work, and which ones are right for you?
Types of Dental and Vision Insurance Plans
Many types of dental and vision insurance plans exist, but they fall into a few basic categories. These include:
- Indemnity insurance: With an indemnity plan, the insurance company pays the dentist or optometrist. They pay a specific percentage of costs, which vary with the type of service, whether there’s a copay and how long the policy-owner has paid on the plan.
- Health maintenance organizations (HMOs): HMOs create a contract between the dentist or optometrist, stating the cost of services, which service providers agree to stick to. HMOs usually minimize or eradicate waiting periods, insurance caps and other extraneous costs, while encouraging preventative treatments. Some services do have limitations, however.
- Preferred provider network (PPO): This is an organization run by medical staff, hospitals, clinics and health centers. Anyone who is part of this network is considered a preferred provider, eligible for set, lower rates from the insurance company with which they contract.
These types of insurance have different ways of paying. What they have in common: The policy-holder pays a premium every month to remain eligible for services. That entitles them to get those services at the rates specified by their provider/insurance company.
What may differ: The amount of the copay may change, the amount of the deductible (how much the policy-holder is responsible for before services are covered) can differ mightily, from $0 to thousands of dollars, and the fee schedule may vary.
Typically, though insurance plans follow the 100-80-50 rule. That means the insurance company will pay for 100 percent of preventative care, 80 percent of fillings or other minor vision and dental procedures, and 50 percent of major procedures. Depending on insurance, the company may leverage a high deductible instead, and once it is met, pay much larger percentages of expensive procedures.
What Do Dental and Vision Insurance Premiums Cover?
So, exactly what do premiums cover? Obviously this varies between dental and vision, so let’s break those down separately.
Dental plans typically cover:
- Teeth cleanings
- Fillings and root canals
- X-rays and other diagnostics
- Bridges
- Dentures
- Major surgery
Usually, dental insurance does not cover any part of a procedure that is considered purely cosmetic.
Vision plans usually include:
- Vision tests
- Corrective lenses
- Glasses
- Checkups
- Eyewear repair
- Eye procedures
- Major surgery
When deciding whether or not to opt for vision and dental insurance – or to offer it to employees – it’s critical to consider how much each of these procedures costs on its own.
What Does It Cost If You Don't Have Insurance?
The cost of procedures varies by location, clinic, age and other factors. Typically, though, the following procedures are between $100 and $150:
- Teeth cleaning
- Dental X-rays
- Dental fillings
- Vision exams
- Eyewear
Crowns can run up to $1,000, while root canals are often almost as much, if not more. Also, it’s important to remember that root canals almost always require a crown following the procedure, making the total cost closer to $2,000.
Depending on the dental or vision surgery, the policy-holder may have to pay anywhere from hundreds to thousands to tens of thousands of dollars to take care of issues that, with insurance, could be resolved with only a few hundred dollars out of pocket – or less.
Are Dental and Vision Insurance Plans Worth It?
When considering whether or not you should offer dental and vision insurance plans to your employees, take into account both the financial and the non-financial costs of doing so. On the financial side of the spectrum, you usually pay less in salary if you offer these benefits, so that can help balance out the cost of the plan and make it more affordable.
Moreover, by bundling dental and vision, you save on the cost of both, making the prospect much more doable. Often, insurance companies will lock your rates – and those of your employees – if you sign up for both policies at once or guarantee a certain length of time. Some plans even include orthodontics.
Then, consider the non-financial benefits. It’s not unknown for a talented employee to decide between Company A and Company B based on insurance, especially those who have young families at home. If you want to attract and retain the best people at your company and be seen as a great place to work, dental and vision insurance are a pretty small price to pay.
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