Eyes and Teeth: When are they Covered?

Your eyes and your teeth have something in common: They tend to be treated differently than the rest of your body when it comes to health benefits. In fact, you often have to purchase separate, voluntary plans for routine dental and vision coverage, and you might have a lot of choices. Understanding what is and isn’t covered can help you choose the plan that’s right for you and get the most out of it.

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, but, generally, vision and dental plans cover basic care and prevention measures. Regular check-ups usually are covered, along with routine care and maintenance, but the amount of coverage depends on your plan and the specific care you receive. Cosmetic measures usually are not covered by dental plans.

When do my health benefits cover my eyes and mouth? Basically, any time you face a medical condition or problem related to your eyes or mouth, such as disease or injury, your health benefits will serve you better than your dental or vision benefits. Sometimes they’ll work in tandem.

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

How can I make sure I get the right coverage? First, check your plan. If you’re not sure of something, contact your HR department or benefits provider. Second, make sure your vision and dental care providers have claims-filing information for your health plan. Third, talk to your care provider, asking if he or she thinks a particular visit or treatment might be covered under your health benefits. If there’s any question at all, ask them to contact your benefits provider.

Get checked. Regardless of your coverage, get regular dental and vision check-ups. Routine visits not only
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 for them to be the first to discover serious diseases such as cancer and diabetes.

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