Whether you’re an HR professional shopping for dental coverage or a broker preparing clients for open enrollment, it’s important to have a strong understanding of the available plans. Nearly all plans have limitations, and learning more about them can help you make the best decision for your company or client. One example is the missing tooth clause. This guide will explain what you need to know about the clause, what it means for members, and Beam’s stance on it.
What is a missing tooth clause?
It's estimated that 69% of adults from 35 to 44 years old have lost at least one permanent tooth1. When a person loses a tooth — whether because of a severe cavity, mouth injury, or another issue — a dentist can replace it with a dental implant, bridge, crown, or dentures. These procedures are considered major by most dental insurance companies, meaning they’re more costly than a routine cleaning or even a filling.
Under a dental plan with a missing tooth clause, however, insurance won’t cover the cost of the replacement procedure if the tooth was extracted or fell out before the current coverage began for the member. To put it in health insurance terms, it’s similar to a pre-existing condition. Members who have a plan with a missing tooth clause would then have to pay for the procedure out of pocket, which can create financial hardship.
Does Beam have a missing tooth clause?
Beam doesn’t have one! We cover repair and replacement procedures for members who had a tooth extracted prior to having dental coverage through Beam. We still recommend that members request a pre-treatment estimate from their dentist and submit it to us. This gives them an idea of what their out-of-pocket expense will be.
Note that if employers choose to mandate a waiting period, the member will have to wait the specified amount of time before getting the tooth replaced. However, if employers do not implement a waiting period — which is standard for Beam plans — members can get the procedure done as soon as their policy is effective!