With the rapidly rising cost of dental and vision care, some of you have probably skipped a few trips to the dentist or ophthalmologist. That being said, dental and vision related conditions are on the rise, so detecting them early with regular check-ups can save you from spending a fortune on restorative care. For example, in the case of tooth decay, the World Health Organisation (WHO) reported that an astounding  60-90% of school children and nearly 100% of adults have dental cavities. Vision impairment is also becoming more prevalent. A study published in the Journal of Ophthalmology predicted that half the world’s population will have myopia by 2050.

We all know how important it is to stay healthy, and maintaining good dental and eye health is no exception. That is why many people are seeking dental and vision insurance, so that they can secure protection for themselves as well as their family from the exorbitant fees associated with these types of treatment. This article by insurance advisor Pacific Prime details the things you should know about dental and vision insurance plans.

An overview of the types of dental and vision insurance

Typically speaking, dental and vision insurance plans tend to be purchased as an optional add-on benefit to your existing health plan, so that all your coverage benefits will fall under one single policy at an additional premium. Providers will usually refer to this as a ‘rider’.  In some cases, these types of plans can also be purchased as a separate plan customized for mostly dental and vision coverage.

Types of dental coverage

The two main types of dental cover are Routine Dental Treatment and Major Dental Treatment. Routine Dental Treatment will typically cover more common types of dental care, such as teeth cleaning, fillings, consultations, root canals, and emergency dental work. Major Dental Treatment offers more comprehensive coverage for restorative care such as gingivitis treatment, bridgework, orthodontic work (e.g. braces), and root scaling.

Types of vision coverage

Broadly speaking, the two types of vision cover options available are the Vision Benefits Package and the Discount Vision Plan. The Vision Benefits Package will tend to provide coverage for eyecare services, eye exams as well as frames and lenses. There will usually be a co-payment for this type of plan, meaning that you will have to pay a fixed amount for every ophthalmic service (as agreed before you sign up on the plan). The Discount Vision Plan will have a much lower premium, covering a similar range of benefits as the Vision Benefits Plan, but instead of paying out your claims, as the name suggests it works out by giving you a percentage discount instead. More elective treatment like LASIK eye surgery are usually not covered, but offered as a discount.

Read the fine print

While it may be tedious to read through all the terms and conditions set out in your policy, it’s highly recommended that you are aware of what exactly you are covered for, as this could save you a lot of money. For example, you may be lured into a plan with a cheaper premium, but find out that your coverage limit is extremely low. Some of the things you will have to look out for include the waiting period, pre-existing condition exclusions, and to check if your plan has a preferred network of providers.

There may be a waiting period

Most add-on ‘riders’ (especially in the case of dental plans) will have a waiting period, meaning that there will be a set duration of time from the moment you purchase your policy where you will have limited or no benefits. This is to prevent people from buying insurance right before they require expensive treatment. Waiting periods vary vastly between plans, ranging from anywhere between 1 month to 2 years.

Do you have a pre-existing condition?

There will usually be clauses set out in insurance plans to limit coverage for people with pre-existing conditions. For dental insurance, this may include: no coverage for the continuation of orthodontic work, exclusion of coverage for replacing a tooth that was extracted before you purchase the plan, and no coverage for replacing relatively new crowns. In the case of vision insurance, some plans will count severe myopia as a pre-existing condition, which means that frames, contact lenses and laser surgery won’t be covered.

Check if your plan has a preferred network of providers

To reduce the cost of premiums, many insurance companies will establish a network of providers covered by their plans. So if you’re going to see a dentist or ophthalmologist, be sure to double check that this provider will be covered by your insurance plan, as using out-of-network providers will not be covered and you may end up with a steep bill to pay.

With so many things to consider, it may be tough to navigate through all the different plans available. This is why it often helps to talk to an experienced insurance advisor to work out which plan best suits your needs.


About the author

If you are looking for the most reputable and trusted insurance plans on the market, Pacific Prime – a global health insurance advisor will definitely be able to help you. Their team of experienced insurance advisors offer a wealth of experience that you can rely on.