Dental and Vision Plans

Dental Insurance: Something to Smile About?

Dental insurance programs cover a wide range of benefits and services. Some leading plans include:

• Indemnity - is the most common type of dental insurance, the business owner or consumer pays annual or monthly premiums in exchange for dental services. Coverage is often capped, with the plan paying up to a set amount for dental work. Most indemnity programs let patients choose any dentist, and the provider will pay up to 100 percent of standard fees.
• Dental Health Maintenance Organization (DMHO)- these programs pay policyholders' annual premiums to visit dentists within the network a set number of times a year. In turn, the dentists receive a flat rate for providing care. Plan members do not choose their dentist, nor does coverage apply for out-of-network dentists.
• Preferred Provider Organization (PPO)- allows policyholders to choose their dentists from a predetermined network of providers and then pay for discounted dental services, with possible surcharges. While participants may visit out-of-network dentists, this can be a costly option.
• Discount Dental Plans (DDP)- discount dental plans have no service caps. Dentists in DDPs simply agree to provide pre-negotiated discounted care to group members. Patients must pay out of pocket for the services they receive at the special rates.

Vision Plans: A Clear Picture

Vision benefits supplement health insurance policies, offsetting the high costs of regular eye exams, prescription eyewear and the like. Vision insurance can be obtained by individuals (purchasing their own plans); through groups, including an employee's company; or through government programs, such as Medicaid. Often vision insurance is considered a wellness benefit coupled with HMOs, PPOs and indemnity (traditional) health insurance, which is contracted with networks providing eye-care services. Available plans typically include:

• Vision Benefits Package- for a yearly deductible, membership fee and/or co-pay, members with a vision benefits package are provided with eye care services. Plans vary, from basic coverage to enhanced products. Basic packages typically cover preventive eye exams, eyeglasses or contact lenses. Some provide allowances for more costly designer frames, specialty lenses and LASIK surgery.

  Before accessing services, however, participants may have to pay a set deductible. After that, they make fixed co-pays to a network provider each time they use eye care services. On the downside, vision benefits packages usually do not offer unlimited access, with eye-care services available a fixed number of times annually.

• Discount Vision Plan- this type of program provides lower-cost eye-care services upon payment of annual fees or membership dues. Premiums vary according to the coverage brand, and the number of family members enrolled. Participants either show a vision plan I.D. card and pay the provider directly or make advance discount payments to the plan provider by using a coupon or debit card. Enrollees can usually access eye-care services as often as needed. If they choose to use non-network providers, participants must pay in full when services are rendered. They may later request reimbursement for any amount eligible for coverage.