Deciphering Dental Insurance Terminology

May 28, 2024
Dental Insurance

Navigating the world of dental insurance can sometimes feel like deciphering a foreign language. With a myriad of terms and verbiage to understand, it’s no wonder many people find themselves confused when trying to make sense of their coverage.

By gaining a better understanding of key terms, you can empower yourself to make more informed decisions about your dental health and insurance coverage. In this blog, we’ll break down some of the most important terms you should know when it comes to dental insurance.

Key Terms Used in Dental Insurance

  1. Premium: The amount you pay to your dental insurance company or third-party administrator, usually on a monthly or yearly basis.
  2. Deductible: This is the amount you must pay out of pocket before your dental insurance kicks in. For example, if your deductible is $500, you’ll need to pay $500 for covered services before your insurance starts to cover any costs.
  3. Covered Services: This refers to the specific treatments, procedures, and preventive care that are included in your insurance plan. These services are typically outlined in your policy and may vary depending on the type of plan you have. When you receive covered services, your insurance provider will pay a portion of the cost, as specified in your plan, while you may be responsible for copayments, coinsurance, or any amounts not covered by your plan.
  4. Copay: A copayment, or copay, is a fixed amount you pay for a covered service, such as a dental visit or procedure. Copays can vary depending on the service provided.
  5. Coinsurance: Coinsurance is the percentage of costs you share with your insurance company after you’ve met your deductible. For example, if your coinsurance is 20%, you’ll pay 20% of the covered expenses, and your insurance will cover the remaining 80%.
  6. Annual Maximum: This is the maximum amount your insurance will pay for covered services within a plan year. Once you reach this limit, you’ll be responsible for paying any additional costs out of pocket.
  7. Lifetime Maximum: Similar to the annual maximum, the lifetime maximum is the total amount your insurance will pay for covered services over the lifetime of your plan.
  8. Coordination of Benefits: If you have more than one dental insurance plan, coordination of benefits determines which plan pays first and how much the secondary plan will cover.
  9. Exclusions: These are services or treatments that your dental insurance plan does not cover. It’s important to review your plan’s exclusions carefully to understand what services you may need to pay for out of pocket.
  10. Maximum Plan Allowance: This is the maximum amount your insurance will pay for a specific covered service. If your dentist charges more than the maximum plan allowance, you may be responsible for paying the difference.
  11. Waiting Period: Some dental insurance plans have waiting periods before certain services are covered. It’s essential to understand any waiting periods associated with your plan to avoid unexpected costs.
  12. Preauthorization: The process of getting approval from the dental insurance company before receiving certain dental treatments or procedures, often for more expensive or specialized treatments.
  13. In-network: Dentists who have agreed to accept negotiated rates from the insurance company for covered services. Using in-network providers usually results in lower out-of-pocket costs for the insured individual.
  14. Out-of-network: Dentists who have not agreed to accept negotiated rates from the insurance company. Using out-of-network providers may result in higher out-of-pocket costs for the insured individual.

Navigating Deductibles, Copayments, and Coinsurance in Dental Insurance Plans

Understanding how deductibles, copayments, and coinsurance work can help you manage your dental expenses more effectively. Here are some tips for navigating these aspects of dental insurance:

  1. Understand how deductibles work. Take note of your plan’s deductible and plan your dental care accordingly. Consider scheduling routine check-ups and cleanings early in the year to help meet your deductible sooner.
  2. Manage copayments and coinsurance for various services. Familiarize yourself with the copayment amounts for different services covered by your plan. Knowing what you’ll need to pay out of pocket for each service can help you budget accordingly.
  3. Minimize out-of-pocket expenses. Take advantage of preventive services covered by your plan, such as routine cleanings and check-ups, to maintain good oral health and avoid costly treatments down the road. Additionally, consider using in-network providers as it will typically result in lower out-of-pocket costs.

Conclusion

Understanding dental insurance terminology is essential for making informed decisions about your coverage and managing your dental expenses effectively. By familiarizing yourself with key terms like deductibles, copayments, and coinsurance, you can navigate the complexities of dental insurance with confidence. Remember to review your plan’s coverage details carefully. Empower yourself with knowledge and take control of your dental health and insurance coverage today.

Visit the dental & vision insurance page to see current rates, review plan details, and enroll in minutes.

long-term disability

Long-Term Disability Insurance: Top Questions

March 12, 2024
Long-Term Disability Insurance

Long-term disability insurance (LTD) is a critical but often misunderstood aspect of financial planning. It provides a safety net in case you become unable to work due to a disability, ensuring that you can continue to meet your financial obligations and maintain your quality of life. In this blog, we will answer some of the top questions people have about long-term disability insurance, shedding light on its importance and how it can benefit you.

What’s the difference between short-term and long-term disability insurance?

Short-term disability insurance typically covers disabilities that last for a few months, providing benefits that kick in quickly to replace a portion of your income.

Long-term disability insurance is designed for more extended periods of disability, covering you for several years or even until retirement if necessary. Long-term disability insurance offers more comprehensive coverage, ensuring you have financial support over the long haul.

What’s the difference between long-term disability and long-term care insurance?

Long-term disability insurance replaces your income if you’re unable to work due to a disability.

Long-term care includes services that meet the medical and non-medical needs of people with disabilities, chronic illnesses, or cognitive disorders who can’t care for themselves. Long-term care insurance covers the cost associated with this type of care for an extended period of time, at home or in a long-term care facility.

Both types of insurance serve different purposes and should be considered separately in your financial plan.

Won’t social security and workers’ compensation cover my needs?

Social Security disability benefits and workers’ compensation can provide some financial support in the event of a disability, but they have limitations. Social Security disability benefits often have strict eligibility criteria and may not replace your full income. Workers’ compensation only covers disabilities resulting from work-related injuries or illnesses. Long-term disability insurance offers broader coverage by providing a benefit when you are unable to work due to a covered disability, regardless if the disability is work-related or not.

How much coverage will I need?

Factors to consider include your monthly expenses, existing savings, and any other sources of income. Calculating the appropriate coverage amount ensures you’ll have the financial support you need without overextending your budget.

Here are a few things to keep in mind when calculating coverage:

  1. Assess Your Existing Financial Resources: Start with your income, and take into account any existing disability benefits you may have, such as employer-sponsored disability insurance, Social Security Disability Insurance (SSDI), or personal savings. These resources will reduce the amount of coverage you need.
  2. Determine Your Monthly Expenses: Start by listing all your monthly expenses, including rent or mortgage, utilities, groceries, transportation, insurance premiums, and discretionary spending. Be as comprehensive as possible.
  3. Consider the Benefit Period: Decide how long you want your disability insurance to provide benefits. Common benefit periods are 2 years, 5 years, or until age 65. Longer benefit periods typically require higher premiums.
  4. Determine the Benefit Amount: Disability insurance typically replaces a percentage of your pre-disability income. This percentage can vary, but it’s often around 60-80% of your pre-disability earnings. Use this percentage to calculate the benefit amount.

Don’t forget to account for taxes. Remember that disability insurance benefits may be taxable depending on whether you pay the premiums with pre-tax or post-tax dollars. Adjust your calculations accordingly and be sure to consider how inflation can affect your expenses over time.

Everyone’s financial situation and insurance needs are unique, so it’s important to personalize your calculations based on your individual circumstances and preferences. You should also be aware of policy exclusions, as certain conditions may not be covered, and consider how these exclusions could affect your overall coverage. A professional insurance agent or broker can also help you navigate these exclusions.

Why do young people need long-term disability insurance?

Many young individuals underestimate the importance of long-term disability insurance. However, disabilities can strike at any age, and statistics show that disability incidence among younger demographics is more common than you might think. One in four of today’s 20-year-olds will become disabled before retirement age.

Enrolling in disability insurance early not only protects your future income but also typically results in lower premiums. Investing in your financial security while you’re young can provide peace of mind for years to come.

How does the application process work?

The application process for long-term disability insurance involves several steps. Once you’ve researched and chosen a policy, you or your insurance agent or broker will complete an application. Here is some information that may be required:

  • Personal information such as name, date of birth, contact details.
  • Employment information, including current occupation and employer.
  • Income details, including gross annual income and any other income sources.
  • Medical history, like current health status, present and past medical conditions, medications, surgical history, etc.
  • Information about lifestyle, such as smoking and alcohol consumption.
  • Financial information, like mortgage, rent and other debts.
  • Additional documentation may be required.

It’s essential to be thorough and accurate in your application to avoid potential delays in the process. Once your application is submitted, the process can take two to six weeks, depending on the benefit amount selected and the complexity of your personal situation. Sometimes, the carrier may require you to get a medical examination or provide additional healthcare records so medical underwriting can be completed.

Once any documentation or requirements are met, the next step is review and approval or denial of your application, followed by a policy issuance if approved.

Conclusion

Long-term disability insurance is a critical component of financial planning, providing essential protection in the event of a disability. By obtaining LTD coverage, you can ensure that you’re prepared for the unexpected and can maintain financial stability in challenging times.

Visit the long-term disability insurance page to view instant quotes and apply online.

 

This information is provided for educational purposes only; it is not intended as investment or financial planning advice. Please consult a financial professional before making an investment or insurance decision.

Top Dental Issues to Watch for in Children

June 13, 2022
Dental Insurance

Lifelong oral health problems often begin in childhood, which is why it’s important to develop good oral health habits when your child is young. While there are many different types of dental issues, here are some of the most problematic to look out for in children:

Tooth Decay

This is the most common dental problem found in children. Baby teeth are especially prone to decay because they’re softer and more fragile than permanent teeth. Tooth decay occurs when acids and bacteria break down enamel and penetrate deeper layers in the tooth. This penetration leads to a cavity, which can then cause pain, infection, and if left untreated — an abscess formation.

According to a 2019 report from the CDC, 80% of children in the U.S. begin brushing their teeth later than dentists recommend. To prevent this problem, begin a twice-daily brushing regimen (using fluoride toothpaste) with your child as soon as their first tooth appears. It’s also important for parents to teach their kids to eat a balanced diet and avoid excessive sugary drinks and candy.

Pediatric Gingivitis / Gum Disease

Gum disease, also referred to as gingivitis or periodontal disease, is caused by bacterial infections and can lead to bleeding gums and bad breath. Children who develop gum disease may need antibiotics or other medications. The best way to prevent gum disease is with regular visits to the dentist every six months.

Broken Teeth and Grinding

From the playground to the soccer field to backyard hide-and-seek, children are prone to accidents — and are therefore more susceptible to breaking or chipping their teeth. A fractured tooth can be extremely painful, so contact your dentist right away if this happens to your child.

Surprisingly, teeth grinding often begins during childhood or adolescence. If you are seeing patterns of headaches, neck pains, jaw pain, or earaches in your child, they could unknowingly be grinding their teeth. If left untreated this can cause long-term damage to enamel and dentin, so let your child’s dentist know if any of these symptoms come up.

Thumb Sucking

Thumb sucking is one of the most common behaviors associated with early childhood. Excessive thumb sucking can have lifelong effects such as improper jaw alignment, overbites, crossbites, crowding of the teeth, malocclusion, and speech difficulties. If you notice your toddler excessively sucking their thumb, attempt to change their behavior by replacing it with pacifiers or finger foods such as carrots, celery, or apple slices (when they are old enough). If your child continues thumb sucking past age three, consult your dentist.

Dental Anxiety and Phobias

Some kids may experience extreme fear or anxiety over going to the dentist. This is normal but if it becomes too much, there are ways to help them overcome their fears. Scheduling regular checkups with your child’s dentist from a young age can help normalize the experience and ensure that any dental problems are caught and taken care of early on. It may also help to talk to them about oral health at home and set a good example by taking good care of your own oral hygiene.

Ready to take the first step on your family’s road to great oral health? Members have access to group rates on PPO dental plans! Visit our dental page to view plan details and enroll today.

I Have Long COVID, Am I Entitled to Disability Benefits?

May 9, 2022
Long-Term Disability Insurance

After living in the shadow of the global COVID pandemic for more than two years, the world is ready to move on, but the virus continues to show that it isn’t ready to leave us just yet.

According to Worldometer, nearly 480 million people have contracted the virus and recovered. But what this number doesn’t show are the millions of people who have recovered yet are still experiencing the long-term effects of the virus.

What is Long COVID?

Long COVID can occur in anyone previously diagnosed with the virus, regardless of severity. According to a recent study of nearly 2 million people diagnosed with COVID-19, 23% of participants continued to show at least one symptom of the virus for more than 30 days after their initial diagnoses.

The Centers for Disease Control (CDC) says that “people with post-COVID conditions can have a wide range of symptoms that can last more than four weeks or even months after infection. Sometimes the symptoms can even go away or come back again.” The CDC lists the official symptoms for Long COVID as follows:

  • Tiredness or fatigue that interferes with daily life
  • Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
  • Fever
  • Respiratory and heart issues
  • Difficulty breathing or shortness of breath
  • Cough
  • Chest pain
  • Heart palpitations
  • Difficulty thinking or concentrating
  • Headache
  • Sleep problems
  • Lightheadedness
  • Pins-and-needles feelings
  • Change in smell or taste
  • Depression or anxiety
  • Digestive issues
  • Diarrhea
  • Stomach pain
  • Joint or muscle pain
  • Rash
  • Changes in menstrual cycles

Is Long COVID a disability?

In July 2021 the U.S. Department of Justice and the U.S. Department of Health and Human Services jointly published guidance on how Long COVID can be a disability under the Americans with Disabilities Act. If Long COVID symptoms are substantially limiting your major life activities, you should begin documenting your symptoms, compiling relevant medical records, and looking into which resources are available — as you may be eligible for disability benefits.

What is long-term disability insurance?

Long-term disability insurance helps provide a monthly income if you become disabled due to a covered accident or illness. This coverage can help pay credit card bills, mortgages, college tuition, and more if you’re unable to work because of a disability.

As an AMSA member, you already have access to group long-term disability insurance. For details including eligibility requirements visit our long-term disability page to learn more.

Debunking the Most Common Long-Term Disability Insurance Myths

August 16, 2021
Long-Term Disability Insurance

When was the last time you thought about what would happen to your family if you suddenly couldn’t work? If you have to think about it, then chances are, it’s been a while.

The simple truth is that one out of every four workers will be diagnosed with a long-term disability before they reach the age of retirement. But despite this startling statistic, many still feel like long-term disability insurance is coverage they can live without.

Myth #1: “I have enough protection through Workers’ Comp and Social Security.”

According to the Council for Disability Awareness, only approximately five percent of accidents or illnesses are workplace-related meaning that the other ninety-five percent will not be covered under workers’ comp.

When seeking to collect social security disability benefits, you may be in for a wait of anywhere from three to five months for an initial decision to be made regarding your case. If like 66 percent of applicants, your application is denied, you have the option to appeal, but in 2017 the backlog of appeals cases hit over one million with an average processing time of over fifteen months, according to research conducted by Allsup.

Can your family really afford to wait for benefits when you need help?

Myth #2: “I’ll still have to fight for a payout in the event of a long-term disability diagnosis.”

We’ve all heard stories about people struggling to receive payout benefits from their insurance company. However, not all of these cases are related to long-term disability insurance and those that are, are very rare.

Upon enrolling, all of your benefits and circumstances surrounding a potential payout are laid out in front of you. If you aren’t going to receive the amount of coverage you are looking for, then it may be worth looking into other options.

Myth #3: “I can’t receive long-term disability insurance because I’m a government employee.”

If you are a government employee enrolled in a Federal Employees Retirement System (FERS) plan, you are still able to apply for long-term disability benefits. According to the Council for Disability Awareness, “While you can buy private supplemental long-term disability insurance in addition to having FERS benefits, you may not get as much coverage as you expected.”

Getting the Coverage You Can Count On

Ready to make sure your family’s financial future is secured in the event you are diagnosed with a long-term disability? To learn more about long-term disability insurance, please visit the info page.

The 3 Most Important Reasons to Invest in Dental Insurance

June 7, 2021
Dental Insurance

Over the last year we’ve spent a lot of time focusing on staying healthy. We’ve washed our hands to the tune of happy birthday, worn face masks in public, and stayed home instead of going out. But when was the last time we focused on our oral health? Science has shown that problems that begin in our mouths can have an impact on the rest of our bodies.

But aside from daily flossing and brushing, taking care of our teeth and gums can be expensive. Dental insurance can help you cover the cost of keeping your teeth and gums as healthy as possible.

So, what else can dental insurance help you cover?

1) Emergencies

Dental pain is often a double-edged sword. There’s the physical pain – and for those without insurance – the pain of a hollowed-out wallet.

If you find yourself experiencing tooth pain, there’s a chance it is the result of something left unattended for too long and now requires major restorative work.

Most dental insurance plans offer deep savings on major restorative dental work and cover all or most preventative care which can help you avoid dental emergencies in the future.

2) Prevention

The American Dental Association recommends that you visit a dentist at least once a year for an exam and cleaning.

You may not always know what dangers could be just around the corner for you and your pearly whites—but a dentist can. Minor issues can lead to bigger and more costly ones down the road.

But the good news is that costly and painful dental problems can often be avoided with regular visits to a dentist and maintaining an oral hygiene routine at home.

3) Orthodontia Coverage

According to the Pennsylvania Dental Association, roughly 4 million people in the U.S. wear braces. But perfectly straight teeth can come at a hefty price.

The cost of dental braces can range anywhere between $3,000 and $10,000 (not including any other orthodontia services that may be required to help you achieve perfectly straight teeth).

And while not all dental insurance plans cover orthodontia, the ones that do can save you thousands, making you or your children’s path to a great smile a lot less painful.

Keeping Your Smile Bright

Dental insurance can help you and your family maintain your smiles for years to come. Tackle dental emergencies knowing you’re covered, address concerns before they become problems, and prevent future issues while saving on your out-of-pocket costs.

Visit our dental insurance page to see rates, review plan details, and enroll today.

How to Work From Home With Pets

April 5, 2021
Pet Insurance

Millions of Americans are having to adjust to working remotely due to the COVID-19 pandemic. In addition to all the technological changes that has led to, it also means that you and your family have had to adjust to significant changes to your routines—including those involving your pet.

Pet owners should spend 1-2 hours a day with their cat or dog. But when working from home, you can expect that amount of time to increase. It’s important to develop a new sense of normal with your pet, without them expecting your complete attention during working hours.

So, what can you do to make sure you’re still able to be productive while working from home?

Start the Day Off on the Right Paw

When working from home, it may be tempting to sleep in without having to worry about the commute, but that extra time in the morning may be better spent with your pet. Providing food and playtime in the morning will help tire your pet and leave you with more time to work uninterrupted.

Redirect Attention

Have an upcoming call or task that will require your undivided attention and concentration? Be sure to attend to your pet’s needs in advance. Potty breaks, food and water, and toys can help keep your pet distracted and entertained without you (at least for a while).

Practice Positive Reinforcement

Has your coworker been good? Reinforce their good behavior with treats, their favorite toy, or some one-on-one playtime. As with any kind of training, it’s important to reward good behavior and work to improve the bad.

Keeping Your Pet Healthy

As of August 2020, only 20 dogs and cats have been positively diagnosed with COVD-19 in the United States. So while it is possible to pass the virus on to your pet, it appears to be far less contagious to animals than it is to humans.

If your pet ever does get sick, the cost of treatments and medications can put an unnecessary strain on your finances. To help offset these costs, we have teamed up with Nationwide to offer discounts on pet insurance to members. To learn more, or to request a quote, please visit the pet insurance page today.

woman smiling while on her computer

The 2021 COVID-19 Special Enrollment Period: What You Need To Know

February 15, 2021
Health Insurance (Individual)

On Thursday, January 28, 2021, President Biden announced plans to reopen the federal health insurance markets for a nation-wide Special Enrollment Period. This action is being taken in response to the massive economic effects of the COVID-19 pandemic which has resulted in some of the highest unemployment rates in decades.

When does it start, and how long does it last?

The 2021 Special Enrollment Period will begin on February 15 and run through May 15, 2021. Coverage effective dates for those who enroll during this time will begin on the first day of the month following an enrollment date. (For example, an enrollment date of March 4 will have an effective date of April 1.)

Will there be another Open Enrollment Period later this year?

Yes. The annual Open Enrollment Period will run from November 1 through December 15. Individuals who enroll during this time will have a January 1, 2022 coverage effective date.

I enrolled during the Open Enrollment period last year. Will I need to sign up for my plan again?

No. If you are currently enrolled in health insurance coverage, you do not need to enroll again. However, if you are interested in changing your coverage, this is your chance to secure ACA-compliant health insurance outside of the annual Open Enrollment Period. Just keep in mind that if you decide to change your plan, your deductible and out-of-pocket maximum will reset based on your new coverage details.

Is this only available to those impacted by COVID-19?

No. Even though this is being called a 2021 COVID-19 Special Enrollment Period, you do not need to have experienced COVID-19, or even a Qualifying Life Event to enroll in (or change) coverage.

Get Ready to Apply

To learn more or to begin shopping plans, visit our Health Insurance page or schedule an appointment to speak with a licensed benefits counselor.

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