What Does Eyecare and Dental Insurance Cover?

Insurance companies that provide vision and dental care plans may work either in connection with regular health insurance providers, offering consumers extra coverage in addition to those policies, or they may stand on their own. Vision and dental plans may not cover every possible problem. You might need to pay for some kinds of care out of your own pocket. Although they can reduce your expenses, they have some limitations.

Riders Are Usually Separate

Even when a vision or dental insurer works with your health insurance provider to increase your coverage, it usually involves a separate policy. These aspects of care aren't merged with your health insurance policy. You or your employer can purchase a stand-alone vision or dental plan without buying into the health insurance policy as well.

Medical Insurance Addresses Some Issues

Your health insurance policy typically covers some eye care and dental problems. You wouldn't need an additional policy to address these. For example, if a vision problem is caused by a health problem like diabetes, your regular health insurance policy may cover this care. If you suffer injury to an eye or your teeth as the result of an accident, your regular health insurance policy would probably pay for this. Vision and dental plans usually cover routine checkups and dental work, as well as other necessities like eyeglasses and contact lenses. They may cover some surgeries.

There May Be Limitations

Your regular optometrist, ophthalmologist, or dentist may not participate in the vision or dental plan you choose or that your employer provides for you. In this case, you must either switch doctors or pay the bill yourself, then submit it to your insurer for reimbursement. The plan may or may not reimburse you, depending on the details of your policy. Some vision and dental plans cap out at a maximum dollar amount of care you can receive each year. If you have extensive work done and exceed this amount, you're usually responsible for paying the balance. In addition, these plans often involve deductibles. You might be asked to pay for the first few hundred dollars of your care each year before the benefits kick in.

Health Care Reform May Not Address Policies

The Affordable Care Act (ACA), scheduled to go into effect January 2014, will not affect most vision and dental plans. The ACA will not require employers to provide these plans or to contribute to them, nor will you be required to purchase such policies if you don't want them. An exception exists if the coverage is contractually part of another policy that your employer pays for without any contribution from you. In this case, you don't have the option to decline.

An Insurance Lawyer Can Help

The law surrounding vision and dental insurance plans and claims is complicated. Plus, the facts of each case are unique. This article provides a brief, general introduction to the topic. For more detailed, specific information, please contact an insurance lawyer.

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