NJ Dental Insurance

Option 1: Horizon Dental Centurion

Cost:$60 per single or $84 per covered family.

The Horizon Centurion Dental Program is an affordable individual and group dental program. Horizon Centurion offers reduced fees to members when they obtain their eligible dental services from one of the participating dentists in our Horizon Dental PPO Network.

These dentists have agreed to accept less than normal fees for all eligible dental services. When members use these dentists they will only be required to pay the dentist the reduced fee and will not be balanced billed for charges above that amount. The Horizon Centurion Dental Program is the ideal way for members to obtain affordable dental care.

Option 2: Horizon Individual Dental Plan –

Cost $180 per person per year and an additional $68.40 for each dependent child

Horizon Individual Dental offers eligible preventive and basic services with no deductible or copayment. Other eligible major services are available at significantly reduced fees. Horizon Individual Dental uses the Horizon Dental Choice Network of participating dentists.

In case you are still on the fence on whether to purchase dental insurance or not, please read what Horizon Blue Cross has to say on the matter.

Did you know your dentist can spot serious health risks?

Routine dental visits can do more than keep your teeth clean. They also provide early detection of serious health risks like diabetes. Recent studies show that periodontal disease is one of the complications brought on by diabetes; a staggering one-third of people with diabetes have severe periodontal disease. And, if you have already been diagnosed with diabetes, periodontal disease can make it more difficult for you to control blood sugar levels.

Horizon Blue Cross Blue Shield of New Jersey strongly believes in working with our members to help them take control of their health. We have the ability to integrate medical and dental care to provide comprehensive solutions to your health care needs through our dental awareness programs. If you are a Horizon BCBSNJ member and have diabetes, you will receive valuable educational material highlighting the link between diabetes and good oral health.

We recognize the connection between good oral care and good overall health. If you have not seen your dentist recently, make an appointment right away.

If you have started the process of getting dental insurance quotes for your business, you know that it can be tough to determine the best plan option with all of the moving parts involved. There is price, network, in an and out of network coverage considerations and more!

One of the important pieces to understand, that many people(including brokers) seem to overlook is comparing the differences of UCR and MAC payments. When looking over your many quotes you will notice that they will say UCR at 90th percentile, or UCR at 80th percentile or MAC, or maybe something totally different. These are important numbers which I will explain below.

First a quick definition:

UCR stands for usual, customary and reasonable – The insurance company will take the average price for a given service in your geographical area and base their reimbursements on these numbers. Let’s say in your area, 80 percent of dentists charge $1,000 for a root canal. $1,000 is the UCR for a root canal in your area.

Maximum Allowable Charge – The maximum allowable charge is based on what the insurance carriers in-network dentists charge for a given service. In-network dentists will typically accept a lower payment for services so for the same root canal as above, the MAC for a root canal may be $650

Why All this Matters?

You have no doubt noticed the certain plans may be cheaper than others. Here is where the UCR and MAC kick in.

Let’s compare the options in a few real world scenarios.

Example 1: UCR at 90th Percentile

Plan covers 50% of the charge on out of network services. Payment is based on 90th percentile of the UCR.

Your dentist charges $1,000 for the root canal and the UCR is $1,000.

Your insurance company pays at the 90th percentile so they will pay 50% of the $900 or $450.

You pay the remaining $550 to your dentist and go on your way.

Example 2: UCR at 80th Percentile

Plan covers 50% of the charge on out of network services. Payment is based on 80th percentile of the UCR.

Your dentist charges $1,000 for the root canal and the UCR is $1,000.

Your insurance company pays at the 80th percentile so they will pay 50% of the $800 or $400.

You pay the remaining $600 to your dentist and go on your way.

Example 3 – MAC – Maximum Allowable Charge

Plan covers 50% of the charge on out of network services. Payment is based on the Maximum Allowable charge.

Your dentist charges $1,000 for the root canal but their network dentists have negotiated a payment of $650.

Your insurance company pays based on the MAC so they will pay 50% of the $650 or $325.

You pay the remaining $675to your dentist and go on your way.

Summary:

When looking at the three options, the potential out of pocket can range from $550 to $675 for a root canal. This may not be a big deal but it is useful information to use if you are trying to upgrade your plan (go for a higher UCR) or downgrade and save some premium dollars(MAC) plan. It is also good to know if you have many employees who will use mostly out of network services compared to in-network so you can tailor the plan to fit your demographics.

Out of network based on MAC – Good (lower premiums, higher out of pocket)

Out of network based on UCR 80th percentile – Better

Out of network based on UCR 90th Percentile – Best (higher premiums, lower out of pocket)

If you need assistance quoting dental insurance for your company or would like me to review your plan, please contact me here.

Affordable Dental Insurance from Horizon Blue Cross Blue Shield