The Spirit Dental Blog | Stay In The Know

Meet Tom Mayer - The Fascinating and Slightly Unorthodox Leader of Spirit Dental

Ask Tom Mayer for his actual job title and you’re likely to hear one of several monikers.  “I prefer Rainmaker,” is one of his favorite answers.  He prefers it so much, in fact, that he’s been using it on his business cards and website.  “Saying CEO or Founder is so boring,” claims Mayer.  “What do words like that tell you about someone’s responsibilities within their company?”

Rainmaker seems a fitting description for the man at the helm of Spirit Dental and its parent company, Direct Benefits. His track record for business savvy and chutzpah dates back to his childhood. (A “kid-for-rent” lawn service, started by Mayer at age 11, proved to be the springboard for a succession of highly profitable enterprises that Mayer has successfully launched, grown and sold over the years.)  Indeed, Mayer’s story reads more like a classic tale of a self-made, American entrepreneur than a resume.   The son of an elementary school janitor and a very artistic mother, Mayer credits his father for his work ethic and his mother for the ingenuity that has driven Spirit Dental’s innovative product design.   “But it was really my dad’s experience with inadequate dental insurance – and the financial hardship that created for our family – that drove me to start Spirit Dental,” says Mayer.  As a school employee, Mayer’s father had one of the best plans in the industry.   But his diabetes caused lifelong dental issues.  Often, his yearly $1,000 maximum was gone by February.   “That’s when I was a kid,” says Mayer.  “You know the worst part of that story?  The worst part is that a $1,000 maximum was still considered the gold standard until about 2001.” 

That’s when Mayer founded Spirit Dental.

According to Mayer, the dental insurance industry has been dominated by a handful of behemoth providers for decades.  As a result, he says, the American public has come to believe that all dental insurance is expensive, difficult to acquire, and rarely sufficient to cover major procedures.   “We rejected that thinking,” says Mayer.  “And we began designing our products from the consumer’s point of view.” 

Today, Spirit Dental offers a range of products to families and individuals, including retirees, that Mayer says are superior to anything else on the market.  But, he is quick to add, creating better products was the easy part.  Changing Americans’ beliefs about dental insurance has proven to be the challenge.

“When people start looking for dental insurance, they look at the same old companies that have been doing this for decades,” says Mayer.  “And they see pricing and coverage limits that make them think they can’t afford to protect their oral health.”  As a result, says Mayer, people have begun seeing dental insurance as a luxury.  It’s a view that Mayer sees as potentially life threatening. “Studies have shown correlations between gum disease and heart disease, diabetes, and other serious illnesses,” says Mayer.  “Just a simple, routine dental check up can uncover up to 120 illnesses early enough for them to be treatable.  But every year, increasing numbers of people choose to skip their visits to the dentist because of the cost.  That’s pretty scary when you realize that 75% of American adults have some form of periodontal disease and don't even know it.”  Perhaps even scarier is the fact that more than one fifth of all American adults and 15.6% of American children (ages 6-19) have untreated cavities, placing them at risk for potentially fatal infections.

Those are the reasons that Spirit Dental exists, says Mayer. “We’ve set big goals for this company, but making a whole lot more money isn’t one of them,” he says.  “Our goal is to start a revolution within the dental insurance industry.”  With that, Mayer reiterates his open invitation to American consumers, whether they currently have dental insurance or not:  “Take 30 seconds out of your day.  Get dental insurance quotes from Spirit Dental, along with our (much larger) competitors. I guarantee you, you’ll see the differences.”  After that, says Mayer, consumers can choose their next step.  “We would love to see everyone sign up with Spirit Dental.  But we would be just as happy if they went back to their giant insurance companies and asked them why they won’t provide $3,500 annual maximums, no waiting periods, and coverage of major procedures,” says Mayer.

Mayer, a self-described “very private person,” says calling himself the Rainmaker means being willing to go to whatever lengths necessary to achieve the company’s goals.  “So, if I have to dress up like the Tooth Fairy and ride around town, on my motorcycle, inviting people to take the 30 second challenge, that’s what I’ll do.”

To learn more about Spirit Dental and Tom Mayer, please visit us at www.spiritdental.com.  Click here to get your Spirit Dental 30 Second Quote.
(To see Tom Mayer as the Tooth Fairy, click here.)

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America’s Hidden Health Care Crisis: Retirees Face Dwindling Dental Coverage

The Truth About Senior Dental Insurance
If you are one of the many working Americans who believe their employer’s retirement benefits include dental insurance, you may be in for a rude awakening:  growing numbers of American employers are dropping their retiree dental benefits. And if you were thinking that Medicare would provide any kind of dental safety net, there is worse news: in most cases, Medicare does not.

Each year, more American retirees are surprised to learn that, if they want dental coverage, they will need to purchase it themselves, as stand alone dental insurance. Many simply choose to go without. Today, roughly 75% of people age 65 and over have no dental coverage whatsoever. Their reasoning may be understandable. In a recent AARP study, 53% of Americans age 50 plus, said they worry they will encounter health expenses after retirement that they won’t be able to afford. Yet, while budgeting for health care coverage, they seem to view their dental health as a luxury. While it may be tempting to view dental insurance as a non-essential, it is inaccurate. And it is dangerous.

The Dental-Medical Connection
According to the Mayo Clinic and the Centers for Disease Control (CDC), regular dental check-ups – and the prompt treatment of any dental issues that they uncover – are keys to warding off serious illness. Indeed, countless studies show the link between gum disease and medical conditions such as diabetes, heart disease and stroke. But consider this: 75% of American adults are unaware that they have periodontal disease, increasing their risks of complications associated with these other diseases. And nearly 20% of people age 65 and over have untreated dental cavities, putting them at risk for potentially fatal infections. 

The great news is that a routine dental exam can result in the early detection of more than 120 diseases.  The bad news for American seniors: fewer than 2/3 of them went to the dentist in 2012. 

The simple truth is, regular, rigorous dental care is not a luxury.  It is a necessity (if your goal is to enjoy great physical health as you age). But it has become an increasingly unattainable one. Dental care costs have increased steadily over the past several years, while most dental plans available today – even if they are employer supported – provide such meager coverage that trips to the dentist have become a significant financial burden. In his recent Huffington Post article, journalist and health care reform advocate, Wendell Potter pointed to the fact that typical plans include 50% copays for procedures such as crowns and bridges, have “missing tooth” clauses, and top out with $1,500 annual maximums that fall far short of the annual dental costs that many of us face.  With out-of-pocket expenses like these, Potter worries that many of us are delaying those trips to the dentist, and putting our overall physical health at risk.

An Open Invitation from Spirit Dental
Tom Mayer, Spirit Dental’s founder and CEO, agrees.  He says he designed Spirit Dental's insurance products to address the concerns that retirees face today, “because I wanted to create dramatically improved, affordable dental insurance for people like my dad.” Mayer’s father, a school janitor, was a diabetic who suffered the many dental complications associated with diabetes. “By January of each year, he would have his annual deductible spent.  The rest of the year, he paid for everything himself.”

Mayer says his goal is to improve the level of dental coverage in this country.  And he’d like to start that dialogue with this open invitation: “Take 30 seconds out of your day. Get dental insurance quotes from Spirit Dental, along with our (much larger) competitors. You will see the differences.”

After that, says Mayer, consumers can choose their next step: “sign up with Spirit Dental or go back to the giant insurance companies and ask them why they won’t offer you $3,500 annual maximums, no waiting periods, and coverage of major procedures,” says Mayer. Either outcome would be a success to him. “I’m not trying to grow Spirit Dental a lot bigger,” says Mayer. “I’m trying to change the national conversation about dental insurance.”

To learn more about Spirit Dental and Tom Mayer, please visit us at www.spiritdental.com.  Click here to get your Spirit Dental 30 Second Quote.

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Dental Insurance in America – Common Misconceptions

Americans shopping for dental insurance often face conflicting reports and mixed messages about the various options available to them. At Spirit Dental, we believe that shoppers should be presented with all the facts to make informed decisions. So in upcoming stories/posts, we’ll explain some common misconceptions about dental insurance – and what you should look for to find the plan you need.  

Tom Mayer



Need for Dental Insurance
The National Association of Dental Plans reports that nearly 127 million Americans lack dental coverage -- more than a third of the U.S. population! But many people are coming to understand that preventive dental care – like other forms of preventive health care – not only helps them stay healthy, but also is more cost-effective. In fact, the American Dental Association reports that for every dollar spent on preventive dental care, Americans save $7 dollars later on.

However, shopping for dental insurance is not a walk in the park. Because so many Americans are unfamiliar with dental coverage options, many fail to understand what they’re getting when they sign on with a plan. The bottom line is that dental coverage plans often highlight the positive plan features and bury the problems in the fine print.

Discount Dental Plans vs. Fully Insured Plans
Discount dental plans, sometimes called dental price clubs, have been around since the early 1990s. They provide members with discounts on fillings, exams, routine cleanings, and other dental services.  Subscribers pay monthly or yearly membership fees and participating providers accept a pre-negotiated fee as payment for services, usually at the time of service. Discount plans are not insurance. Spirit Dental is insurance.

Annual Maximums for the 21st Century
Spirit Dental pays up to $3,500 of dental expenses per person each year, twice as much as many dental insurance plans.  Says Spirit Dental CEO Tom Mayer: “The 20th century dental insurance plan is dead!  The old days of your dental insurance plan only paying $1,000 a year are over.” With Spirit Dental plans, dental bridges, implants or root canals, which can cost thousands of dollars, are covered.  And don’t forget – no waiting!

Waiting Periods
Many dental insurance plans have waiting periods on major services, like crowns, bridges, dentures and implants. Some discount plans still subject members to a waiting period before their discount is applied. Spirit Dental has NO waiting periods on major services.

Provider Network Options
Many discount plans require the member to use a participating provider in a limited network. Spirit Dental insurance plans allow the freedom of choice to use a network provider or go to the dentist of your choice.

Spirit Dental or Discount Plan? You Be the Judge
If you want to choose your own dentist, schedule an immediate appointment, and receive expanded annual coverage, the choice is clear: Spirit Dental beats other dental insurance and discount plans.

  • Choose Your Own Dentist
  • No Waiting Periods for All Services
  • $1,200, $2,500 or $3,500 Annual Maximums
  • 3 Cleanings Covered Per Year
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The Power of No Waiting

Back to school season has always been a good time for Jane to get organized. After shopping for clothes, school supplies, immunizations and medical check-ups, she finally made time to shop online for dental insurance. She was confident that she’d covered all the bases without breaking the bank –x until her son broke a tooth in football practice. Then, the truth came out – there was a waiting period on her new dental policy and the trip to the dentist wasn’t covered.

The waiting period also surprised Dick, who had purchased an online dental plan a few months before he bit into some hard candy and broke an old filling. Ouch! It hurt even more having to pay full price at the dentist after paying the monthly premium.

Only Sally is smiling today. She compared a number of dental insurance plans and chose Spirit Dental. Affordable, broad coverage and best of all – no waiting!

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No annual deductible? It’s true!

We all know the importance of staying healthy, from head to toe, and this often comes with a price. Especially when we take preventative measures, like ensuring we have vision & dental insurance. Unfortunately, if you have to pay the full cost of dental care, you may have a hard time paying your dentist bills. Perhaps even more seriously, without dental coverage you may be tempted to skip regular cleanings and checkups, a decision that could lead to serious dental health problems.
One of the nuisances of insurance is having to pay the deductible. Most dental plans have a specific dollar deductible that you must pay annually. Therefore, during a benefit period, you have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment.

Do you ever wish you could skip this annual deductible?  Well now you can!  Spirit Dental & Vision plans offer a $100 lifetime deductible.  In other words, there are no annual deductibles.  You pay $100 once and never again.  Visit http://spiritdental.com/ for more details.

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Are you Considering Dental Implants?

Missing teeth are nothing to smile about. But with dental implants, you can fill those gaps permanently, brighten your smile and boost your confidence. Unlike dentures or removable bridges which may be loose or uncomfortable, dental implants look better, feel better and give you back your biting power. Corn on the cob, anyone? 


The Dental Implant Downside
Unfortunately, replacing missing teeth with dental implants isn't always an option. Why?

  • A basic dental implant typically costs $1,250 to $3,000 -- or as much as $60,000 for a full set of implants on both upper and lower jaws. Clearly, dental implants are a major investment. 
  • Because implants are classified as cosmetic dental procedures, they are often excluded by dental insurance. Other dental insurance plans offer some coverage but require waiting periods of up to five years before implant coverage begins. Other insurance plans exclude implant coverage if it’s linked to a pre-existing condition. 
 

All Spirit Dental Plans Cover Tooth Implants
With Spirit Dental, you don’t have to worry about exclusions buried in the fine print. Our policy is clear: Every Spirit Dental plan covers tooth implants. With Spirit Dental you also have more flexibility, more preventive care and more annual coverage. 

  • Choose your own dentist
  • No waiting periods
  • Guaranteed acceptance
  • Implants and major services covered
  • 3 cleanings per year
  • $1200, $2500, $3500 annual maximums
 
More Questions? 
  • Why don’t all dental plans cover implants?
    • Implants first came into practice in the 1990s, and are still considered a cosmetic solution. Because implants are more expensive than bridges or dentures, dental plans often choose the most affordable fix. If you compare dental insurance companies, you’ll find Spirit Dental among the leaders in implant coverage.
  • What is reasonable and customary?
    • The term “reasonable and customary” refers to basic norms regarding procedural costs. While dental procedure costs vary by region, a generally accepted “reasonable and customary” cost helps guide reimbursement. Find out your cost with a simple Spirit Dental 30-second quote.
  • Are there any waiting periods?
    • Many dental insurance policies impose a waiting period on certain procedures. With Spirit Dental, there are no waiting periods. Period.
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Medicare Advantage Plans to Cut Dental Coverage in 2014! What to Do?


Do you rely on a Medicare Advantage plan for inpidual dental insurance and visual insurance? If you do, your coverage may end later this year due to Affordable Health Care Act budget cuts. What should you do?

Finding affordable dental care can be challenging—but you have options. If you need a new dentist, it’s good to know that most dentists are doing everything they can to make their services more affordable. Today, most dentists offer or accept savings plans, and many provide new-patient specials that give you free first visits and treatment discounts. In-house or third-party financing -- with reasonable payment plans – are often available. If you’d prefer inpidual dental insurance to fill your coverage gap, you’ll find the plan and the coverage you need at Spirit Dental.

Look to Spirit Dental for Affordable, Same-Day Coverage

With Spirit Dental, you’ll find a flexible, affordable plan that fits your needs and your budget. Click us for 30 second online quote today and compare our rates and our benefits with other plans. You’ll see why Spirit Dental offers the best dental insurance plans in America. With a Spirit Dental plan:

  • Choose Your Own Dentist
  • No Waiting Periods
  • Guaranteed Acceptance
  • Implants and Major Services Covered
  • Three Cleanings Per Year
  • Choose From $1,200, $2,500, or $3,500 Maximums

More questions? A Spirit Dental has the answers you need:

  • Are there any waiting periods?

Never. At Spirit Dental, when you sign up, you’re in. The power of no waiting can be yours!

  • My dentist has never heard of Spirit Dental. Do they have the resources I need?

Spirit Dental is backed by the top insurance carriers in the industry -- Security Life and Spirit PPO. Don’t worry. When you need us, we’ll be there for you.

  • What is an annual maximum?

With most dental insurance, coverage for your dental care ends when you reach the annual maximum payment – usually about $1,500. Spirit Dental offers a range of plans to suit your needs, including plans with an annual maximum of $3,500.

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Saving on Child Orthodontia

How Can I Save Money on My Kid’s Braces?

Many parents run into serious issues when their kid’s permanent teeth come in. According to Betterhealth, your central incisors or your “two front teeth” begin to arrive at just 6 to 7 years old and your last “adult” teeth or molars come in on average at 13. Most parents are hopeful that their children will never need braces. Some may think, “Since I didn’t need them my children won’t either”. Yet most orthodontists would disagree and estimate that “roughly 45 percent of children need braces to fix functional problems such as a misaligned bite, but up to 75 percent of kids could benefit from them to straighten their teeth” (Health.com). Without dental insurance, the overall cost of braces can be expensive. The cost of hardware and orthodontist treatments will range from $4,000 to $8,000 dollars. In the likely scenario that your child needs braces, what is the best way to save money?

The answer is dental insurance for children. Most insurance companies do not cover orthodontia, so it is important to find one that does. The main issue with orthodontic coverage is that it is not typically provided immediately upon enrollment. By getting your family insured earlier rather than later, you can save big.

An example of a plan that is great for orthodontic savings is the Spirit PPO plan. PPO means that you have a network of dentists who agree to lower their prices for services, making it cheaper for you and your family. Under this plan, aside from getting dental exams and cleanings for free, you will also get Basic, Major, and Ortho Services at least partially covered. Without coverage you might end up having to pay 100 percent out of pocket. Whether your child has to get braces for physical reasons or you want him or her to grow up with a wonderful confident smile, reconsider investing in a family dental PPO insurance plan.

-Written by Anthony Calderon

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Insurance - The lottery you don't want to win

This is a simple phrase that explains the role of insurance in modern life.  Whether it is insurance that is mandatory, like auto insurance, or elective like dental it is important to understand why insurance is worthwhile, and how it works.

Let’s take auto insurance as an example of how insurance works.  Drivers have the same general risk, getting into a car accident.  The risks vary from a few hundred dollars for a “fender-bender” to millions due to injury.  While only a few of us will encounter the worst, we all want to be protected from that risk.

The insurance company determines that for every X number of people who pays insurance, one person will need to have coverage for the worst.  The money needed to pay for that person’s catastrophic accident, and smaller claims, is the largest part of your insurance premiums.  The rest of your premium goes to overhead costs, and keeps the insurance pool large enough to pay any claims.  For insurance to exist, more people must pay more than they will ever get back from a claim.  Considering what would need to happen for us to get our money back, most of us would consider that a lousy lottery to win.

Thankfully when it comes to dental insurance the same concepts apply, but the risks are considerably smaller.  Dental insurance plans also pay out less than what most people put in.  Only if you have serious dental work to be done can you expect to “get your money’s worth,” or get ahead at the end of the year.  But dental insurance does help spread the cost out over a year, and many plans save you money if you go to a network dentist (see also: PPO, HMO, DHMO).  With dental insurance most of us hope we never need to file that big claim, but it is important to know that if we need to it is there.

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Is there such a thing as full coverage dental insurance?

Is there such a thing as full coverage dental insurance?

This is a question we get quite often, and the short answer is no.  Dental insurance will not cover every procedure you will need at 100%.  Dental insurance is a tool to help protect you from extremely high dental bills, but even with the best coverage you will be paying something out of pocket.  Most dental insurance will cover preventive or routine work like cleanings and exams at 100%, but coverage for basic or major work will have some limitations.

The most comprehensive dental insurance on the market typically limits coverage for basic and major work in a couple ways.  First, most plans include a waiting period for basic and major services.  The waiting period is typically 12-18 months of coverage under the plan, although some procedures like fillings may only have a 6-9 month waiting period.  Spirit Dental has no waiting periods for Basic or Major Services.  Coverage starts as soon as your plan does!

The second way dental plans limit coverage is through the use of annual maximums.  An annual maximum is the maximum dollar amount an insurance plan will pay out for covered services per calendar year.  This is a real concern for those needing major work because many plans have a low limit, like $1000 or $1500.  If you happen to need a few thousand dollars of work, anything after that amount will not be covered.  Spirit Dental offers three different annual maximums, $1200, $2500 and $3500.

But the most important restriction most plans have is no coverage at all for some procedures.  Many dental plans on the market limit the number of procedures you can have in a period of time, like one crown every year.  Some dental plans will not cover crowns, implants, or orthodontia at all.  Details like this tend to be buried in the fine print, so it is important to look closely at what a plan covers before you decide to buy.  You don’t want to get a plan that does not cover implants or crowns when you know you may need one or both of them in the future.  We are happy to provide a Spirit Dental which does cover implants, crowns, and child orthodontia.

 

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What is the "Exchange"?

What is the “exchange”?

Healthcare reform is here, and a lot of people have important questions about how it affects them and what they may need to do to starting January 1, 2014.  The simple answer for individuals is that if you currently have a medical plan (either with your employer or an individual policy), you do not need to do anything.  For individuals who do not currently have medical insurance, the individual mandate will require you to purchase insurance for yourself (and dependents) or pay a tax (the insurance mandate only applies to medical insurance, not dental insurance.   You are not required by law to have dental insurance).  But the law is also intended to make buying medical insurance easier, and therefore we have the healthcare exchange.

The healthcare exchange is an online marketplace created to provide the public with individual healthcare plans.  The plans on the exchange meet the new standards that healthcare reform requires.  Each state is responsible for either creating their own state-run exchange OR being part federal government exchange.  On the exchange, you will find medical insurance plans and dental insurance plans offered by private companies that are available in your state.  In addition to being a one-stop shop for insurance, the exchange also provides subsidies to make buying medical insurance easier for those with low incomes.

State Exchange Websites (as of 10/15/13):

Federal Health Exchange: https://www.healthcare.gov/

Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, South Carolina, Tennessee, Texas, Utah, West Virginia, Wisconsin, Wyoming

 

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What is a network, what does PPO mean, what is a HMO, and what does Indemnity mean?

The world of insurance is complicated, sometimes needlessly so. One topic we discuss with clients on a daily basis is networks, or more simply “who accepts this plan?” It’s confusing, so let’s start by explaining what a network, HMO, PPO, and Indemnity plan is.

Network is the easiest of these to understand because it is a word used outside of the insurance industry. In insurance a network is a group of doctors that sign an agreement with that network. Doctors (providers) are then bound to the network, which typically requires them to charge members of that network a reduced rate for their services. In return for lowering their prices, network providers (doctors) can expect to receive more customers. Some dental insurance companies keep premiums down by only offering plans that use a network.

Larger networks typically have smaller discounts, while small networks can offer deeper discounts. This is the primary difference between a PPO (Preferred Provider Organization) and a HMO (Health Maintenance Organization). HMO’s generally have less options because less providers are part of the HMO, but the discounts are deeper. PPO’s generally have more providers in more areas, because more doctors agree to the network’s terms and discounts.

HMO’s tend to have less providers but it can also be the most affordable. This is because HMO’s control all aspects of the healthcare. The downside of HMO’s is choice, as you are strongly encouraged to go to a HMO provider.

PPO’s exist to offer clients as many options as possible while keeping premiums down. PPO’s use a network (or multiple networks, the Spirit PPO uses the Careington and DenteMax) that actively recruits doctors to provide care under the PPO. So PPO’s generally have more options than HMO’s, but there are, however many doctors who prefer not to be part of any network.

For clients who want more choice, an Indemnity plan allows them to see any dentist. The Spirit Indemnity plan will pay any dentist a set amount for each procedure. The payments are based on 90% of Reasonable and Customary in each area, meaning that 9 of 10 dentists charge that amount or less. So the Indemnity plan provides coverage with no networks to worry about. The Spirit Indemnity plan is perfect for people who want the freedom to see any dentist.

If you have any questions about this or topic or any others relating to Dental insurance, click to chat or give us a call (800) 620-5010. To see the options we provide in your area click here.

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Adding EyeMed Vision to your Spirit Dental Plan can save you big money

Add the optional Spirit EyeMed coverage to your dental insurance and you'll save if you wear glasses or contacts. Without coverage, an exam and prescription glasses can cost $300 or more. You have EyeMed access to thousands of private practice and retail-affiliated network providers located in convenient neigborhood locations across the country.

Spirit Vision Coverage Highlights

Spirit Dental & Vision’s vision plan is available through the EyeMed Vision Care Network. EyeMed is a leading vision benefits company, offering the following features:

  • Savings on eye care and eyewear 
  • Quality standards for care and materials 
  • Access to thousands of providers nationwide, including the nation’s top optical retail brands 

Copays for Exams Lenses and Frames

  • Eye Exam $10 Copay (Once every 12 months.)
  • Eye Glasses/Lenses $20 Copay (Once every 24 months)
  • Frames $0 Copay (Once every 24 months)

Contact Lenses

  • Contact Lenses (Once every 24 months instead of lenses and frame)
  • Contact lens wearers will pay up to $55 for standard contact lens exam, including fit and follow-up, or receive 10% off retail price for premium contact lens exam, fit and follow-up.
  • Plans include a $100 retail allowance that can be applied toward the purchase of conventional or disposable contact lenses. 
  • If the member chooses conventional contact lenses with a retail price over $100, he or she will receive 15% off the balance. Medically necessary contact lenses are paid in full after the copay. 
  • Replacement contact lenses can be ordered online and conveniently delivered to members’ homes through www.eyemedcontacts.com

Additional Discounts

Spirit Vision members will also receive unlimited additional discounts on purchases made at participating provider locations, including:

  • 40% off additional complete pairs of eyeglasses
  • 15% off additional purchases of conventional contact lenses
  • 20% off non-covered items like cleaning cloths or nonprescription sunglasses

Other non-vision insurance discounts

Coatings and lens treatments can be added for the costs below:

Lense Options

Member Cost

Polycarbonate lenses

Scratch-Resistant coating

Solid or gradient tint

Ultraviolet coating

Anti-Reflective coating

Standard progressive (add-on to bifocal)

Lens options not listed

$40

$15

$15

$15

$45

$65

(20% off retail price)

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New version of Spirit Dental indemnity plan introduced

The Spirit Indemnity Dental Insurance plan helps individuals and families cover the costs of dental care. 

Covered dental services include exams, cleanings, fillings and extractions, as well as crowns, root canals, bridges and dentures.

The policy pays for covered dental expenses based upon a percentage of the reasonable and customary (R&C) fees for those covered expenses after the deductible has been satisfied. 

The percentages are: 

  • 100% for Preventive Services, 70% for Basic and 10% for Major Services in the 1st year.
  • In the 2nd year of coverage, Basic Services increase to 80% and 50% for Major. 
  • In the 3rd year, Basic Services increase to 90%

Highlights of the plan include: 

  • The right to choose your own dentist.
  • Calendar Year Maximums - $1,000, $2,000 or $3,000 per insured
  • Two dental exams and three cleanings are included per calendar year
  • One series of bitewing x-rays per year
  • Space maintainers
  • Sealants (children to age 16)
  • One topical fluoride treatment per year to age 16

Major services include:

  • Simple extractions
  • Implants (endosteal only), up to the allowance for the lowest cost covered traditional procedure
  • One diagnostic x-ray, full or panoramic in any 3 year period
  • Oral surgery
  • Endodontic treatment
  • Periodontic services
  • Restoration services; inlays, onlays and crowns
  • Prosthetic services; bridges and dentures
  • Basic fillings
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New Spirit Careington Maximum Care PPO Dental Plan

The Spirit PPO Dental Insurance plan helps cover the costs of dental care. Covered dental services include exams, cleanings, fillings and extractions, as well as crowns, root canals, bridges, and dentures.

This policy pays you for covered dental expenses for Careington (Maximum Care) PPO Provider or Non PPO providers (Out-of-Network) based on the contracted fee amount negotiated with Careington (Maximum Care) organization after the deductible has been satisfied.

The percentages are: 

  • 100% for Preventive Services, 40% for Basic, 20% for Major and 10% for Ortho Services in the 1st year. 
  • In the 2nd year of coverage, Basic Services increase to 80%, 50% for Major and 25% for Ortho Services.
  • In the 3rd year, Basic Services increase to 90%, Major Services increase to 60% and Ortho Services increase to 50%. 

Highlights of the plan include: 

  • Spirit Dental allows you to select your own Careington (Maximum Care) dentist.
  • Calendar Year Maximums - $1,200, $2,500 or $3,500 per insured
  • Two dental exams and three cleanings are included per calendar year
  • One series of bitewing x-rays per year
  • Space maintainers
  • Sealants (children to age 16)
  • One topical fluoride treatment per year to age 16

Major services include:

  • Simple extractions
  • Implants (endosteal only), up to the allowance for the lowest cost covered traditional procedure
  • One diagnostic x-ray, full or panoramic in any 3 year period
  • Oral surgery
  • Endodontic treatment
  • Periodontic services
  • Restoration services; inlays, onlays and crowns
  • Prosthetic services; bridges and dentures
  • Basic fillings

Children Orthodontia benefits include:

  • Orthodontic care for the proper alignment of teeth is provided only to dependent children who are under 19 when treatment is received
  • Coverage is 10% 1st year, 25% 2nd year and 50% 3rd year with a $1200 lifetime maximum per child
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Give Kids a Smile Day a big hit in Delaware

"Give Kids a Smile Day" was a big success in Upper Darby last week. Over 200 appointments were made to have children's teeth screened during the event held in Upper Darby, Delaware. This was the first year that the event was held in the upper Darby area. Eight dentists from Darby and nearby Philadelphia participated in the event.

The goal of the event is to administer immediate care then help children find a local dentist that they can see on a regular basis. The organizers want to identify children without Delaware dental insurance get them set up with dental care services year round. "We looked into a lot of mouths and solved a lot of potential problems for children this week", said the organizers.

The Give Kids A Smile program began in 2003 under sponsorship of the (ADA) American Dental Association. Dentists and other dental professionals donate their time and services to provide exams, treatments and education. The program started out as a local one day event but has expanded into both local and national events 365 days per year. Each year, approximately 450,000 children benefit from more than 1500 events, all because of the efforts of 40,000 or more  annual volunteers.

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Taking care of baby teeth

 A child's primary teeth, sometimes called "baby teeth," typically begin to appear when a baby is between six months and one year of age, are as important as the permanent adult teeth. Primary, or "baby," teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt.

The ADA recommends that a dentist examine a child within six months of the eruption of the first tooth and no later than the child's first birthday. Consider a dental visit at an early age is a "well baby checkup" for the teeth. Besides checking for tooth decay and other potential problems such as thumb-sucking.

 Parents should take their children to the dentist regularly, beginning with the eruption of the first tooth. Then, the dentist can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children. These home treatments, when added to regular dental visits and a balanced diet, will help give your child a lifetime of healthy habits.

 

 

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Dental access for low income families in Connecticut increasing dramatically

Low-income children from the state of Connecticut are accessing dental care at a higher rate than most other states according to a new report. The report found that children in the state's top ten cities are seeing the dentist as often as their peers with private Connecticut dental insurance. 

Overall, about 300,000 young people in low-income families are getting dental care through the Husky A program. In Hartford and New Britain, that's 75 percent of the kids who are on welfare.

The key to the success in the increase in access has been a higher medicaid reimbursement rate paid to participating dentists which has made it more attractive for them to serve medicaid patients. Reimbursement rates for dentists hadn't been adjusted since 1993. In some instances the rates increased by 100 percent. For a cleaning the amount the dentist get went from only $24 to $65. 

Another key was consolidating the program from four dental providers to only one. The system is now easier for administrators, providers, and patients to work with. The new provider pushed private dentists to participate in a system, which no longer gave insurers incentives not to pay out claims. Members were also sent out reminders to see the dentists.

The result of these actions dramatically increased the amount of participating dental care providers across the state.

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Can your MD perform an oral health exam?

Who is the most qualified health professional to perform an oral health exam?

If you said your dentist you provided the most common and correct answer. While a medical doctor is qualified to do such an exam a dentist is more familiar with the anatomy of the mouth and is specifically trained to identify abnormalities in the mouth, including oral cancer. Therefore, an oral exam by a dentist is still the preferred approach. 

According to the Tufts University School of Dental Medicine, most oral cancers are essentially preventable and with early diagnosis and timely treatment have a good prognosis. The key element is early diagnosis! More than 90% of oral cancers occur in individuals older than 45 years.

According to the American Cancer Society, cigarette smoking is the major single cause of cancer mortality in this country. Smoking is responsible for nearly 1 in 5 deaths in the United States. Men are twice as likely to be affected as women, with the average age at diagnosis of 60 years. American consumers are living longer and therefore oral exams should be performed by dental professionals and should be part of their overall health maintenance.

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Colorado trying to expand lower income dental access

A study completed in 2011 estimates that forty percent of Colorado's 2.1 million residents lack dental insurance coverage. The study also indicated that those without Colorado dental insurance were twice as likely to skip needed dental care due to cost concerns over the coverage. 

According to a study done in 2010 by the Colorado Health Institute only about four out of ten children who have Colorado dental insurance see the dentist regularly. One reason for this could be that even though dental insurance softens the blow to the wallet it still costs money to see the dentist for major services. 

Lower income kids are at the greatest risk for tooth decay and oral health diseases. Getting them to the dentist early and regularly can not only prevent a bunch of pain and suffering it also can save the state millions of dollars in care at emergency rooms plus the loss of overall productivity at work and school.

The (ACA) Affordable Care Act has provisions for covering pediatric dental but finding dentists who will take medicaid is always a challenge. Twenty of Colorado’s 64 counties don't even have a dentist who accepts Medicaid. Only 10 percent of Colorado’s 3,500 or so dentists are considered significant Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Most avoid Medicaid because of low reimbursement rates and extensive paperwork to get qualified.

Oral Health Colorado has set several goals for 2017 that focus on Medicaid utilization:

  • Provide a dental home for every child in the state of Colorado
  • Convince parents take their children to the dentist at least once per year.
  • Dramatically increase the amount of dentist who accept Medicaid for compensation.
  • At least 65 percent of children on Medicaid would get an annual checkup; the Medicaid provider network would grow 20 percent
  • The proportion of 1-year-olds seeing a dentist for preventive care would grow from 3.4 percent to 6 percent
  • 50 percent of Medicaid-eligible pregnant women would receive oral health care.
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