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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
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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
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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.
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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.
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