Dental and Vision Insurance

By Insurance Industry Expert & Author
Updated on
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In this article

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.

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Combined Dental and Vision Insurance Plans

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

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

Vision Coverage (In Network):

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

We can help you find the plan that best suits YOUR needs.

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.

Need help choosing a plan? Call us at 800-296-3800

Our knowledgeable customer service team will assist you with any questions you may have prior to enrolling in a dental plan. They can guide you through the process of choosing coverage that matches your needs as well as your budget.

Dental Insurance