Dental Insurance

It is important for any one to be covered by a dental insurance and it is equally important to health insurance since the dental diseases are common. Being protected by a proper dental insurance plan and using it wisely are necessary safeguards for your entire family. Most of the dental problems are preventable, unlike other medical ailments.

Types of Dental Insurance

There are four types of dental insurance availble. They are :

• Indemnity - Self funded and allows you to see the dentist of your choice without any restrictions.
• Preferred Provider Organization (P.P.O.) - P.P.O is an arrangement between the insurance company and the dentist, whereby the dentist agrees to lower his fees to meet a prescribed fee schedule administered by the dental insurance company and sold to your employer for a reduced insurance premium. You are given a list of providers who honor the P.P.O. program. Most patients assume that you must see a provider on the list only and this is NOT true. What insurance companies fail to convey, is that you can still visit the dentist of your choice BUT it will cost you more as a non P.P.O. dentist has not signed your insurance companies reduced fee contract.
• Health Maintenance Organization (H.M.O.) - Also known as Capitation plans H.M.O’s are generally programs, by which you, as a patient pay little or nothing out of pocket for your dental needs. Your dentist, chosen off a list, is reimbursed monthly at a small flat rate per patient. This money is received even if the patient does not come in or has no treatment done. You must leave the dentist with whom you have established a relationship and choose a new dentist from a list supplied by your employer. Unlike a P.P.O. plan, you can only visit dentists who have contracted with the H.M.O.
• Self Insured - Self funded and allows you to see the dentist of your choice without any restrictions.

An often misunderstood term used by insurance companies is "UCR". This is an arbitrary fee ceiling at which the insurance company will stop reimbursement. After this ceiling, coverage for a particular procedure will cease. Again, this has nothing to do with the fee charged, but with the level of coverage negotiated by your employer.

Got a dental question? Go ahead and ask us using the email form on the top of this page and we will have an answer for you as soon as possible.