The below post is taken from the Video Blog, the Subject Matter Minute. If it’s a little hard to read, it’s because it’s taken from the spoken word. You can view the episode on YouTube if you would like. Find it here: Episode #13 – Dental Insurance.
If YouTube is blocked for you or your agency, you can scroll to the bottom of this post to view it from Google Drive. (I would prefer you view in YouTube, so I know how many people have watched)
You can also listen to an audio version.
Welcome to another subject matter minute I’m Matt Nagy, thanks for joining me.
You might notice something different about me today… I’m sure you do if you’ve been watching. I had to ditch the glasses. The professional in me couldn’t take the glare anymore. I’m sure most of you noticed, I certainly did… I had to kind of tilt my head a little bit down in order to lose it and I’d forget, and that’s awkward. I’ve got to keep the lights… you got to have good light for decent video, so I had to ditch the glasses. Hopefully I don’t look too weird. I can see… I have like 20/30 in one eye on 20/25 and the other, so it’s kind of mostly for computer screens and driving. Although I’m completely used to them now, so everything’s a little fuzzy. Not a big deal.
Today’s topic is rather near and dear to my heart. My wife of 22 years has been a dental hygienist for 23 years, so this topic comes up around the table, around the house, all the time. Today I’m going to talk about our dental insurance.
So dental insurance. Before I go into it, I just want to say that last month’s subject, while there really wasn’t a subject matter expert, I did use the information that A&I, HRD put together on the website. I did the research, so I guess, in essence, I was the subject matter expert, but thanks to HRD for putting together the information. This month, again, I’m doing the research, but I want to give a shout out to Karen Williams of EGI, because I got a lot of the information from her trainings.
So our dental coverage… first of all it’s by Delta Dental, as you probably know, and there’s basically two packages you can get. You can get preventive dental and you can get optional dental. Preventative is required if you have state health insurance, so you have to have it. If you have the health insurance, you have it. Also, you have to have the preventative to get the optional. Another thing is you don’t have to have the insurance to get these packages. If you, for some reason don’t have the state of Wyoming health insurance… if your spouse has better insurance, which I’d be surprised, but maybe that’s case, you can still buy these packages.
One thing to keep in mind when you’re a new employee… if you don’t buy these in the first 31 days there’s gonna be a waiting period. For preventative, it’s just a waiting period till the next open enrollment period, which could be up to a year, but it could be a month depending on when you’ve been hired. The optional dental, which covers more intensive things, we’ll go into that, has a three year waiting period. So if you don’t sign up within that first 31 days you’re gonna have to wait three years before you sign up.
VOICE OVER TO CLARIFY:
“Hold up… actually this waiting period could be longer than three years because you have to do it during open enrollment. So let’s say you’re hired in June… you have to do it during open enrollment of that year so it would actually be about three and a half years.”
That also comes into play if you cancel it. If you have it for a while, drop it, you’re gonna have to wait three years before you can sign back up. Now there are a couple instances where you don’t have to do the three year waiting period. It’s in the Delta Dental book, feel free to check it out.
Let’s talk about what these two things cover. Preventative covers two cleanings and exams a year. It also covers bitewing x-ray once a year, and then a full mouth x-ray every two years. There’s also a few things for kids up to age 18… it covers sealants and the topical fluoride and spacers. I’m not sure what spacers are, but those are covered as well in the preventive. There’s no deductible and it covers 100%.
Now the optional… the optional is for more intensive things, and there is a deductible. There’s a $50 deductible per person or $100 deductible per family, per year. After your deductible is covered, there’s two levels… there’s what they call basic services and major services. The basic services is covered at 80 percent, and then the major services is covered at 50 percent.
Something to keep in mind with the optional dental is there is a $1,500 per year, per person maximum. So if you have $10,000 treatment plan on your messed up mouth, you’re only going to get $1,500 out of this optional plan.
I’m not gonna go into what is in the basic plan and what’s in the major plan. You can find that information down below. I actually copied that section out and put it down there verbatim.
There’s something else to know with our dental coverage… you need to, or you don’t have to, but you need to try to, find somebody in network. There’s two different networks. There’s the premier… dentists who have agreed to accept what Delta pays so you don’t have to pay any extra. There’s also the PPO (preferred provider organization). The deal with them is they’ve agreed to lower their prices so your out-of-pocket is less. They may charge more than Delta pays so you’re gonna pay a little bit out-of-pocket but it’s reasonable.
You don’t have to go with an in-network dentist, but the deal with that is that if you go to an out-of network dentist, Delta will pay at a lesser rate. Also, they don’t have to submit your stuff, so basically in the end you’re gonna probably have to submit your insurance claim to Delta and they’re gonna pay you directly, but at a lower rate. So, really, you should find an in network dentist. There’s plenty of them in Wyoming.
VOICE OVER TO CLARIFY:
“Okay, I may have gotten into the weeds just a little bit too much there. After talking to the folks at EGI, really it boils down to a participating provider or a non participating provider… find yourself somebody who participates.”
After having read through the Delta book, which again is linked down below, I’m gonna have to say that you shouldn’t assume that something’s covered. There’s a lot of exclusions, a lot of fine print, so make sure you go read up before you maybe opt into the optional. Just make sure you’re covered, and you know. Some major things might be covered by health insurance, so you might need to do a little bit of research. Feel free to read through that Delta Dental book. It’s not bad until it gets to the exclusions and the long list of stuff at the bottom, but it’s probably a good idea to check it out.
I think that’s it for today. Thanks for joining me on the Subject Matter Minute! Hope to see you next time, and don’t forget to subscribe!