The Basics of Dental Benefits
Dental benefits can be confusing, but they don't have to be. There are similarities to regular health insurance such as monthly premiums, deductibles, and possible co-pay amounts for office visits. There are also significant differences. Dental care isn't something you might need at some point. Dental care is something nearly everyone requires. As such, dental insurance often pays a lower percentage of your expenses than a medical plan might.
There are two types of dental insurance plans. The first, an indemnity plan, requires the patient to provide payment at the time the service is received and then pays the patient according to the plan benefits. The second, a managed care plan (also called a dental PPO plan), does not require the patient to pay money up front.
Indemnity Plans
A dental indemnity plan typically has a deductible applied to your benefits, but allows the patient freedom to select a dentist without regard to network. You pay the fee at the time of your office visit and then submit a claim to the insurance company. Once your claim is received and processed, direct reimbursement for a portion of the fee comes to you. This plan might pay a higher percentage of your dental bill, but it does require more money up front. For some patients, a significant advantage to an indemnity plan is being able to choose your dentist without regard to networks
Dental PPO Plans
A managed care plan/dental PPO plan will also have a deductible, and can provide lower costs, including less money out of pocket at the time of your dental visit. PPO plans usually requires you to use an in-network service provider, so your choice of dentist is limited. The in-network dentist has a contract with your insurance company to provide services at set rates.
While some PPO plans might allow you to see an out-of-network dentist, your visits may not be covered, or could be covered at greatly reduced benefit (they pay less, you pay more).
In both cases, you may have co-insurance in which you pay up to 30% more for a procedure that is only partially covered under your plan.
Dental Discount Plans
Dental discount plans, which are not actual coverage for procedures within set periods of time, can offer you a reduced rate for services through dentists participating in the discount program.
Most dental insurance providers will allow an individual to purchase a policy for children only. Ask questions, because you might possibly be required to purchase a separate policy for each child. There are also family plans available.
If you have questions about your dental coverage, ask your personnel department or the number provided on your insurance card. Your dental office can also explain your policy and how their charges work. Dental insurance can be confusing, but it doesn't have to be. Know what you need and select the plan best suited to those needs.