Group Dental

Dental Insurance Plans

Dental insurance helps protect you from unexpected dental expenses and makes it easier to afford to keep up the regular checkups, cleanings and other preventive treatments you need to keep your mouth healthy.

Like medical insurance, dental insurance provides benefits for a specific rate or premium. Different plan designs offer various levels of coverage and different choices in which dentists you can visit.

The major differences between dental insurance plans:

  • The choice of dentists
  • Your out-of-pocket costs
  • How dental treatments are paid

Most types of insurance, like a dental PPO, DPO, DHMO or prepaid plan, rely on a network of dentists. These participating dentists agree to perform services for patients at per-determined rates and usually will submit claims for you. You’ll usually pay less when you visit a network dentist. Most (but not all) traditional indemnity or fee-for-service insurance products do not provide a network feature, so you may have to pay for services up front, file your own claims, and wait for the insurance carrier to reimburse you. However, there are advantages such as having the freedom to visit the dentist of your choice.

Dental Plans – Insurance 101

DHMO – Dental Health Maintenance Organization

Typically, the least expensive of dental plans . All dental services are provided by professional dentists who agree to provide specific treatements and services to patients at no charge (some services may require a co-payment). DHMO plans reward participating dentists who keep patients in good health, thereby keeping plan costs low. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.

Indemnity

Usually allows the patient to go to the dentist of their choice. These plans generally pay a portion of the dentist’s fee or a set dollar amount (usually, whichever is less). Payments may be made to the insured member or, by assignment, directly to the dentist. If there is a difference between the amount paid and the dentist’s full charge and the amount paid, the individual usually pays the difference.

PPO – Preferred Provider Organization

Generally less expensive than Indemnity dental plans. Individuals select their dentist from a network or listing of dental providers who have agreed by contract to reduce their fees. Individuals can also seek treatment from dentists outside of the PPO (non-participating dentists) but may be responsible for higher deductibles and/or co-payments.

Scheduled

A scheduled plan or scheduled reimbursement plan reimburses you for a specific amount based on a fee schedule with any balance due being your responsibility. Scheduled plans do include a calendar year maximum, a deductible and have waiting periods on certain procedures. A Scheduled plan shows every covered procedure and the amount you will be reimbursed for each procedure. For example, if the insurance reimburses $47 for a cleaning, and your dentist charges you $50 for a cleaning, you would be responsible for the difference of $3.

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