Considering Dental Insurance?

As of  late many of the insurance carriers that I represent now offer a stand-alone dental plan, not only available with your current health insurance plan.

Before selecting this optional benefit, it is important to understand how dental insurance works.

1. Does your dentist accept the plans terms of service and is he considered to be a "In-Network" or "Out-of-Network" provider.  If your dentist is "In-Network" than the dental plan will provide greater benefits.
2. Preventative Services such as cleanings and X-Rays are covered 100%
3. All plans have a 6 month waiting period for Basic Services (cavities, fillings, extractions) and a 12 month waiting period for Major Services(root canal, crowns, dentures, restorative).  After waiting periods, member pays either 20% or 50% of allowable charges.
4. All costs that are paid out by the insurance carrier are applied towards the plans $1,000 or $1,500 annual benefit maximum

The only way around the waiting periods is acquiring a dental plan from Blue Cross and Blue Shield of Illinois (BCBSIL) that must be taken when applying for a plan of health insurance coverage.  BCBSIL only has a 12 month waiting period for crowns, dentures and restorative.

If your teeth are in great shape and you seek semi annual cleanings, you may want to weigh the cost of coverage to the actual cost you are to pay retail.

If you do not have a dentist, then it might be wise to acquire a plan to cover the cost of your initial "new patient" consultation and cleaning, especially if you plan on going twice a year.

If you just found out that extensive work is needed, your best bet would be BCBSIL since there are not any waiting periods for Basic Services and a few Major Services.  If not BCBSIL, none of the plans will be a benefit.

Fore more information please contact the shoppe.

-The Shoppe

Maternity Coverage in Illinois

Happy Holidays and Merry Christmas!

I hope that the readers of my postings, which are few, had a great holiday weekend :)

As of the past month there have been quite a few inquiries on obtaining maternity coverage in the private market.  Unfortunately, there is only one private health insurance carrier that offers an optional Maternity benefit, Blue Cross and Blue Shield of Illinois (BCBSIL).  This optional benefit must be elected at time of application or on the anniversary date of a current BCBSIL plan.

The benefit is payable after a 12 month waiting period with continual monthly premium payments.  All pre-natal care will be covered after the waiting period to then include delivery and post-natal care.  After the waiting period all covered care will be subject to your plans coverage.  Once post-natal care is completed you will then request to remove the Maternity benefit.

If a plan member with the maternity benefit delivers by Cesarean C- Section and removes the benefit, and is to add the benefit again at plan anniversary, there will be complications.

When applying for the benefit at anniversary, all members of the plan must go through medical underwriting, and until January 1st, 2014 (health care reform), BCBSIL can place condition specific exclusion riders.  For example, BCBSIL would offer the optional Maternity benefit but will place an exclusion on future C- Sections, not covering it at all.

Now...the final thing to mention is the Maternity Benefit that is available with the Illinois Comprehensive Health Insurance Plan (ICHIP).  ICHIP is the state high risk pool and the benefit is available with their Traditional coverage option.  To qualify for this coverage you must not be insurable in the private market or have a private policy that is more costly than the ICHIP.  The optional Maternity benefit has a 9 month waiting period.

For additional information on Maternity coverage please contact the shoppe.

Best,

The Shoppe

BCBSIL has updated their effective date guidelines

Effective 12/1/2010, Blue Cross and Blue Shield of Illinois (BCBSIL) has new effective date guidelines.

You can now request an effective date 2 weeks out from the date you submit your application.  If a decision has not been made within the 2 weeks, your effective date will be on approval, but can not be the 29th, 30th or 31st of the month.

Please contact the shoppe with any questions.

-The Shoppe