The Difference Between Health Insurance And Dental Insurance Policies

Understanding the difference between dental insurance and health insurance policies is important for any individual who wants to take good care of his overall health condition. Although many people believe that medical and dental coverage are similar, it is essential to understand that each type of insurance has different features. In order to get a clear picture of the difference between health coverage and dental insurance, you need to consider their particular characteristics.

Dental care includes molar removal and tooth replacement, basic cavity care, teeth whitening, enamel cleaning, and cavity drilling, as well as complex procedures. A reliable dental insurance policy will cover the costs of regular checkups, dental treatments, and common procedures. When you go shopping for dental insurance, you will be able to choose from traditional insurance, discount dental plans, managed care plans, dental preferred provider organizations (DPPOs), and more. If you buy this type of insurance, you will not have to worry about the high costs of maintaining a good dental health. Although dental care falls under the general health care category, there is a clear distinction between these two terms.

Many health insurance plans cover only routine checkups, simple procedures, medical emergencies, and prescription drugs. However, you can get as much coverage as you need for a higher price. The more coverage that you buy, the more you will have to pay for insurance. You can opt for an individual or a group health insurance plan. It is advisable to search for health insurance policies that cover as much as possible, including previous health issues. Prescriptions, X-ray sessions, and emergency care should also be covered by the health insurance plan that you choose. Keep in mind that a number of factors such as your age, medical history, lifestyle, smoking habits, pre-existing conditions and income determines the cost of health insurance. Like dental insurance, most health insurance policies do not cover cosmetic procedures or any other interventions that are not medically necessary.

Although dental insurance and health insurance policies refer to different things, they work in basically the same way. Regardless of the type of insurance that you are interested in, it is essential to compare multiple quotes side by side before making a decision. You should always look for policies that offer enough coverage at a fair price. Both dental care and health insurance policies are priced very high, so it is up to you to find a plan that suits all of your needs. Remember to ask if there are any bonuses and discounts provided and stick to a policy that offers maximum benefits. In case you need help, do not hesitate to contact an insurance company featuring health and dental insurance plans.

Health Care Reform Implementation Update

Sept. 23, 2010, marked the six-month anniversary of the enactment of the Affordable Care Act. There has been a lot of news coverage on this milestone during the past few days and it is likely that more will follow.

Certain provisions of the Affordable Care Act are effective starting with plan years (in the individual market, policy years) beginning on or after Sept. 23, 2010. We believe that some of our members or groups may not recognize or understand the plan/policy year concepts and mistakenly assume that certain Affordable Care Act provisions will immediately apply to their coverage on Sept. 23, 2010.

We ask that you call us with any questions regarding certain provisions of the Affordable Care Act that may not immediately apply to your coverage, but will apply starting with plan/policy years beginning on or after Sept. 23, 2010.

New EOBs and Language Notifications

Beginning Sept. 23, 2010, members and providers will see a new section in Explanation of Benefits (EOBs) and denial letters that is referred to as “Important Updates (not applicable to all policies or plans)”. The new section informs members that if their plan/policy is non-grandfathered, as defined in the Affordable Care Act, and if their plan/policy has renewed after Sept. 23, 2010, then the information in the new section may apply to them. This would also apply to new plans that are effective on or after Sept. 23, 2010.

These requirements do not apply to grandfathered plans. However, you should note that the new notification language will be included on all EOBs and denial letters, including those to members of grandfathered plans. Our call center Customer Advocates will be prepared to help members determine whether or not their plan is grandfathered or non-grandfathered.

Appeals and External Review

Concerning external review of denials, all non-grandfathered plans that are not required to follow an existing state external review law – for example, most self-insured plans – the option to choose to follow either the existing state external review process (when permitted by the state’s Department of Insurance) or to follow the new federal external review process, as of their effective date.

Non-grandfathered ASO self-funded plans to submit an External Review Election Form for their medical benefit plan(s) to their account representative at least 30 calendar days prior to their renewal date. If they do not make their own selection by completing the form at least 30 calendar days prior to renewal, the states external review process will review it. At this time there will be no additional charge for this new service.

Essential Health Benefits

Starting with plan years beginning on or after Sept. 23, 2010, the Affordable Care Act generally prohibits group health insurance coverage from having annual limits on the dollar amount of essential health benefits.

However, for plan years beginning prior to Jan. 1, 2014, group health insurance coverage may have certain restricted annual limits on the dollar amount of essential health benefits in accordance with federal regulations.

Federal regulations and guidance also provide for the waiver of the restricted annual limit requirements under certain circumstances.

Pre-existing Under 19

Starting with plan years beginning on or after Sept. 23, 2010, the Affordable Care Act prohibits group health insurance coverage from imposing pre-existing condition exclusions on enrollees under age 19. If you missed this announcement earlier, you should note that we have now aligned our benefits with the Affordable Care Act by not allowing pre-existing exclusion only for enrollees up to age 19. This is for our fully insured and individual business – ASO/custom accounts may still vary their coverage to provide richer benefits.

Child-only Policies

We are awaiting state Department of Insurance approvals for our new child-only policy. Our target date to begin enrolling members is May 2011.

Special Open Enrollments

Some groups may be having their open enrollment now for plans starting Oct. 1, 2010. Included in open enrollment for these groups is a special open enrollment for adding dependents under the provision of the Affordable Care Act that extends adult child dependent coverage up to age 26. Those individuals who also reached a plan’s lifetime limit are also eligible for the special open enrollment.

Tags: health care overhaul, health care reform, obama care

This entry was posted on Thursday, September 30th, 2010 at 12:30 pm and is filed under health care overhaul, health care reform, obama care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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