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Dental and Vision Insurance

By Insurance Industry Expert & Author
Updated on

Contents

Why Are Dental & Vision “Excepted” Benefits?

Independent dental insurance and vision insurance are both “excepted” benefits because they are not regulated by major health legislation (such as HIPAA and the Affordable Care Act) despite covering medical benefits. Excepted benefits are viewed as supplemental benefits filling the gaps within primary medical coverage. If dental and vision benefits are included within primary medical insurance policy, they are not exempt from requirements of the Affordable Care Act and HIPAA. However, if a medical plan requires an incremental fee for dental and vision benefits and these benefits can be declined while retaining medical benefits then they are excepted even when bundled with a medical plan.

Alongside dental and vision plans, other examples of excepted benefits include travel insurance and indemnity policies such as hospital insurance and limited scope medical coverage (such as cancer insurance or critical illness insurance).

Stand-Alone Plans

Dental and vision coverage are commonly sold as separate and independent insurance policies. Additionally, neither dental nor vision plans have standardized benefits. The implications of this state of affairs is that considerable coverage differences exist among plans. For example, one dental plan may cover only preventive and basic dental care such as fillings while a different dental plan may cover those services alongside expensive care such as crowns, root canals, and dental implants. With respect to vision plans, there can be significant differences in insurer coverage of eye exams and the amount the plan contributes toward contact lenses, glasses, and frames. For rate quotes for stand-alone vision plans, vision our Vision Plans page.

Combined Dental and Vision Insurance Plans

There are insurance products on the market that combine dental and vision coverage within a single plan. Below are three examples:

Nationwide and VSP Select Plus 1500 + VSP Standard

The Nationwide and VSP Select Plus 1500 + VSP Standard is a Preferred Provider Organization (PPO) dental plan that allows an enrollee to use in-network or out-of-network care, albeit with differing out-of-pocket cost implications.

The Select Plus 1500 + VSP Standard covers preventive dental care with no waiting periods. Basic dental care is covered after six months of continuous enrollment and major dental care is covered after 12 months of continuous enrollment. The vision benefits offer low out-of-pocket costs, savings on progressive lenses, coverage for an eye exam, frame, and lenses every 12 months. The network for vision care includes 36,000 doctors.

Humana Extend 5000

The Humana Extend 5000 dental plan also includes vision and hearing benefits. The Humana Extend 5000 plan's dental benefits include a $5000 per calendar year maximum benefit (per insured person) for preventive, basic, and major dental services. The details of the plan's vision benefits are listed below.

Vision Care Services (In Network):

Routine exam: $0 copay
Rx Glasses: $25 copay
Frame: $150 Allowance
Contacts (instead of glasses): $150 Allowance

Humana Extend 2500

The Humana Extend 2500 dental plan, like the more expensive Humana Extend 5000, packages vision and hearing benefits along with its primary dental benefits. The plan's dental coverage includes a $2500 per calendar year maximum benefit (per enrollee) for preventive, basic, and major dental care. Vision benefits are somewhat more limited than found in the Humana Extend 5000.

Vision Care Services (In Network):

Routine exam: $10 copay
Rx Glasses: $25 copay
Frame: $100 Allowance
Contacts (instead of glasses): $100 Allowance

Nationwide and VSP Classic 2000 + VSP Premium

The Nationwide and VSP Classic 2000 + VSP Premium is an indemnity plan. Indemnity coverage is a fee-for-service dental plan where the insurance company reimburses an enrollee for a portion of covered dental expenses. The reimbursement amount is not dependent on what the dentist actually charges but, rather, the insurance company's own determination of "usual, customary and reasonable" fees.

Nationwide and VSP Classic 2000 + VSP Premium provides preventive, basic, and major dental service coverage with no waiting periods for preventive services. Basic dental care is covered after 6 months of continuous plan enrollment and major dental work (such as a crown or root canal) is covered after 18 months of continuous enrollment. The major features of the plan's vision coverage are:

Vision Coverage (In Network):

Eye Exams: $10 copay
Rx Glasses: $20 copay
Frames: $200 Allowance
Contacts (instead of glasses): $200 Allowance

Trade-Offs between Buying Coverage Separately or in a Bundle

Assuming benefits and out-of-pocket costs are equal between a bundled dental/vision plan versus a stand-alone dental plan and a stand-lone vision plan, the major decision factors are:

A quick note on dentist choice - if you use an out-of-network dentist on a PPO plan, you will likely pay higher out-of-pocket costs than would be the case for an in-network dentist. Be certain to factor those costs in if your dentist does not participate in the network for a plan you are considering.