Dental Plan Articles
1. Getting the Most from Your Dental Plan.
2. Understanding Dental Benefits.
3. Importance of Dental Benefits
Dental Insurance Plans Offered
1. Indemnity Plans
2. Dental HMOs
3. Preferred Provider Organizations
4. Dental Discount and Reimbursement Plans |
Understanding Dental Benefits
Dental benefits offer a great deal of flexibility in terms of the types of services that are covered and the types of plans that are available, and it's important to understand all the options available before choosing a plan.
Coverage for Dental Services
Types of Dental Plans
__________________________________________________________________ Coverage for Dental Services
Preventive Care covers routine check-ups and includes services and procedures used to prevent tooth decay and other oral diseases.
Basic Restorative Care covers common restorative services including procedures to restore damaged teeth and repair dentures, bridges, crowns and inlays. It also covers endodontic, periodontic and surgical procedures used to treat oral disease.
Major Restorative Care covers major dental procedures including the replacement of missing natural teeth with dentures or bridges, and the repair of severely decayed or fractured teeth with crowns.
Most carriers provide coverage for preventive and basic restorative services to encourage members to receive the regular care needed to maintain good dental health. Coverage for major restorative services, as well as riders for orthodontic care, are generally optional. __________________________________________________________________ Types of Dental Plans
Dental plans, like medical plans, can be structured in any number of ways. However, the fee-for-service, dental health maintenance organization and the preferred provider organization (PPO) are the most common. Fee-for-Service/Indemnity Plan: Members receive care from the dentist of their choice, and dentists' charges are based on a fee for each service performed. Some dental programs have contracts with dentists who agree to accept a predetermined fee as payment for services. Dental Health Maintenance Organization: Members pre-pay for comprehensive dental benefits through their premiums and co-payments, and receive care through a limited network of dentists. Dental HMOs generally provide coverage for all basic care, reduce members' out-of-pocket costs and limit paperwork. Some HMO plans utilize a system known as capitation. In capitated plans, dentists accept a per member, per month (PMPM) fee and member co-payments as payment in full for all covered services. Preferred Provider Organization (PPO): Network dentists agree to a negotiated fee schedule as payment for their services, and members are offered financial incentives to use dentists who participate in the network. Patients may choose to receive services from any dentist but will receive the highest level of benefits by selecting a PPO dentist. In some cases, dentists must adhere to quality and utilization controls. |
