Author Topic: Twelve Month Waiting Period for "Major Dental Services????"  (Read 2082 times)

coppertop

  • Bristles
  • ***
  • Posts: 458
Twelve Month Waiting Period for "Major Dental Services????"
« on: October 27, 2015, 09:36:43 AM »
Last year, our firm offered a dental plan to its employees for the first time.  Until last month, however, I was on my husband's dental plan for years, so I didn't subscribe until this month, since my husband left his job.  One of my co-workers found out to her shock and chagrin that she would have to be on the dental plan for more than twelve months before she could have a crown.  She did not know this in advance and in fact, her dentist's office was remiss in that they claimed to have done a pre-determination and apparently, they did not and proceeded with the work anyway.  This cost her $1,300. 

My question is, is this the way it is being done now?  We have Aetna.  In essence, it forces you to pay for the dental plan for more than a year before you get services beyond the basics.  I am on the committee to choose insurance and somehow we all missed this detail.  I'd like to know for future reference if there are better plans available out there that will cover major services in the first year. You never know when a tooth will crack or whatever.  I am pretty disgusted to find this out, and I feel that I and my fellow employees are being ripped off.

HazelStone

  • Stubble
  • **
  • Posts: 118
Re: Twelve Month Waiting Period for "Major Dental Services????"
« Reply #1 on: October 27, 2015, 10:30:28 AM »
This has long been the case on individual plans. The reasons are not hard to figure out. I worked in an insurance agency for a while. This became so predictable that whenever someone called in asking about buying a dental plan themselves, I asked them "What work do you need done?" They were surprised at the guess. The people who asked about buying one ahead of time to be prudent? I got maybe two or three per year. And the math does not work well if you are paying all the premium yourself, anyway.

We didn't sell group plans with that restriction, however- most employer plans don't. The couple of companies we had on hand that required waiting periods on group policies also waived those waiting periods if the company had a dental plan before this.

Nope, your agent/Aetna snuck in a gotcha in order to get the low bid. Benefits budgets have been under more pressure in recent years, and the brokers that submit the low bids generally get the business- even if there are holes in the coverage that they should point out but don't.

Note that the major insurance companies have a wide variety of plans to offer- from gold plated to utter crap. There are lots of ways to cut corners on a benefits package. Having the brand name on the policy shouldn't be much reassurance.

Samala

  • 5 O'Clock Shadow
  • *
  • Posts: 26
  • Location: Orlando, FL
Re: Twelve Month Waiting Period for "Major Dental Services????"
« Reply #2 on: October 27, 2015, 09:32:28 PM »
I've also been on a benefits committee.. waiting periods for certain services were included in many plans we reviewed (see: http://www.guidestone.org/~/media/Insurance/Dental/PremierDentalBeneSum%20pdf.ashx for a good example that highlights the various wait periods) but like HazelStone said if you could prove continuing dental coverage prior to the new policy going into effect the waiting periods were often waived.  This is true for new employees we take on as well, if they had previous coverage they can prove, the waits are usually waived, so long as they enroll at orientation or within a few weeks of their start date. 

There is one odd exception when natural teeth are missing when someone first enrolls, they have to wait (I think it is 12 months) before the new insurer will cover any specific work to address that missing tooth.

Our current dental insurer is Cigna (their Total DPPO plan, similar to what I linked too) and I've been really happy with them - and had extensive work over the last two years with significant savings, nearly zero surprises, and overall great coverage.  There is an annual max benefit ($1500 in that link), but I think most plans we considered also had this feature.  It's not ideal, but I'm sure this cap helps keep cost of premiums for the plan more reasonable.