Eyes and Teeth: When Are They Covered?

Your eyes and your teeth tend to be treated differently than the rest of your body when it comes to health benefits. You often have to purchase separate voluntary plans for routine dental and vision coverage. As a result, some people assume that everything related to teeth and eyes will be covered only if you purchase separate plans. But that’s not the case. Matters related to your teeth and eyes sometimes are covered by basic health benefits. Understanding when they are covered can help you save money and preserve your overall health.

The following Q&A should help you understand how your eyes and teeth are covered.

What is covered by dedicated dental or vision plans? All policies are different. Vision and dental plans generally cover basic care and prevention measures. Regular check-ups usually are covered, along with routine care and maintenance. From there, the coverage varies from plan to plan.

When do my health benefits cover my eyes and mouth? When you face a medical condition related to your eyes or mouth, such as disease or injury, your health benefits kick in. Sometimes they’ll work with your dental or vision plans. Sometimes they’ll be the sole source of coverage. For example, if you have an eye condition related to diabetes, treatment likely will be covered by your health coverage.

Do I need to go to a primary care physician or specialist for dental or vision care to be covered? No. Your vision or dental care provider can bill your health insurance carrier any time your care will be covered.

How can I make sure I get the right coverage? First, check your plan. Contact your HR department or benefits provider if you’re not sure of something. Second, make sure your vision and dental care providers have claims-filing information for your health plan. Third, talk to your care provider. Ask if a particular visit or treatment might be covered under your health benefits. If there’s any questions, ask them to contact your benefits provider. Care providers often default to filing claims the way they usually do. However, you might get a better reimbursement rate from your health benefits provider if the charge is covered.

Get checked. Regardless of your coverage, get regular dental and vision check-ups. Routine visits help to prevent serious vision and dental problems. They also give dentists and optometrists the opportunity to check for bigger health problems. It’s not uncommon to discover serious diseases such as cancer and diabetes during these visits.

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