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Below are the five basic types of dental
insurance plans. These plans are often availiable to both individuals and
groups. Coverage and rates vaire widely.
Indemnity Dental Plans
This type of dental plan pays the dental office (dentist) on a
traditional fee-for-service basis. A monthly premium is paid by the
client and/or the employer to an insurance company, which then
reimburses the dental office (dentist) for the services rendered. An
insurance company usually pays between 50% - 80% of the dental
office (dentist) fees for a covered procedures; the remaining 20% -
50% is paid by the client. These plans often have a pre-determined
or set deductible amount which varies from plan to plan. Indemnity
plans also can limit the amount of services covered within a given
year and pay the dentist based on a variety of fee schedules. Some
typical features of these plans:
- High deductibles before coverage begins (well-designed plans
don't apply the deductible to preventive services)
- Probationary periods on certain procedures that last up to a
year.
- Annual dollar limit on benefits.
- Chose your own dentist.
- Your average monthly cost: $15 to $25.
- Companies selling these plans are regulated by state insurance
departments.
Dental HMOs
These dental insurance plans, also known as "capitation plans," operate
like their medical HMO cousins. This type of dental plan provides a
comprehensive dental care to enrolled patients through designated
provider office (dentist). A Dental Health Maintenance Organization
(DHMO) is a common example of a capitation plan. The dentist is paid
on a per capita (per person) basis rather than for actual treatment
provided. Participating dentists receive a fixes monthly fee based
on the number of patients assigned to the office. In addition to
premiums, client co-payments may be required for each visit. Some
typical features of these plans:
- Monthly premiums (some require you to prepay a year's worth)
- Co-payments for office visits
- Free preventive or routine care
- You must select from an approved network of dentists
- May have an initial enrollment fee
- Annual dollar cap
- Your average monthly cost: $5 to $15
- Companies selling these plans are regulated by state insurance
departments.
Preferred Provider Organizations
Another true insurance plan, a Preferred provider organizations (
PPO) falls somewhere between an indemnity plan and a dental HMO.
This plan allows a particular group of patients to receive dental
care from a defined panel of dentists. The participating dentist
agrees to charge less than usual fees to this specific patient base,
providing savings for the plan purchaser. If the patient chooses to
see a dentist who is not designated as a "preferred provider," that
patient may be required to pay a greater share of the
fee-for-service. A group of dentists agrees to provide
services at a deeply discounted rate, giving you substantial savings
as long as you stay in their network. Unlike the more restrictive
DHMO, though, you can go out of network and still receive some
benefits. Some typical features of these plans:
- Monthly premiums
- Annual dollar cap
- You must stay within the approved network of dentists or pay
higher deductibles and co-payments
- Your average monthly cost: $20-25
- Companies selling these plans are regulated by state insurance
departments.
Dental Discount
This type of dental plan is not insurance. The managing
organizations have negotiated with local dental offices to establish
a set price for a particular dental procedure and offer deep
discounts (some up to 70%) off the regular ADA pricing code. This
plan has several advantages over traditional dental insurance plans,
namely, there are no exclusions for pre-existing conditions. This
allows a patient to receive immediate coverage for work without
meeting any waiting period requirements.
Direct Reimbursement Plans
A dental care plan now coming into vogue is the direct
reimbursement plan. This is a self-funded benefit plan not
insurance in which an employer pays for dental care with its own
funds, rather than paying premiums to an insurance company or
third-party administrator. You, the patient, pay the full amount
directly to the dentist, then get a receipt detailing services
rendered and the cost, which you show to your employer. The employer
reimburses you for part or all of the dental costs, depending on
your specific benefits.
Your company might reimburse 100 percent of your first $100 of
dental expenses and then 80 percent of the next $500, and 50 percent
of the next $2,000, with a total annual maximum benefit of $1,500.
Or it might reimburse only 50 percent of your first $1,000,
resulting in a $500 yearly cap.Some typical features of a direct
reimbursement plan:
- Neither you nor your employer pay monthly premiums
- Freedom to choose any dentist
- Typical employer cost: depends on the number of employees and
- benefit caps
- Benefits usually capped at $500 to $2,000 annually.
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