Keep in mind that this page offers a brief summary and the actual specifics of the plan will be spelled out in a contract between the employer and the dental plan administrator.The employer enters into a dental plan contract with a third party that will act as the plan administrator.
Here are three reasons why: The amount your dentist may charge you and the amount your dental plan may reimburse you for might be different because these two prices are not derived in the same way.
When your employer and insurance carrier determine the amount of money your dental plan will pay for services covered under the plan, they take into account the specific circumstances of your company and its employees.
If your dental treatment is only partially covered, you will have to share in the cost of your dental care. All treatment and care decisions should be made by you and your dentist based upon your actual needs, aside from your dental plan coverage.
Your dental plan is not necessarily a treatment plan! Dental Plans There may be a difference between the price your dentist may charge you and the amount covered by your dental plan.
For example, a toothache can result in oral infection if not treated on time.
This can pose a great risk to patients who are in poor overall health, particularly those who suffer from heart disease.
Sometimes additional information may be requested by your plan administrator in order to ensure that the treatment is covered by your plan.
In such cases the plan administrator will write to you and ask you to obtain the information from your dentist.
The Patient's Responsibilities There are more than 30,000 dental plan contracts in Ontario, and each one is a little different from the next.
As a smart consumer, you should make it your job to understand the details of your dental plan, and to supply your dental plan administrator with necessary information such as pre-treatment forms, claim forms or any supplementary information.