Dental Insurance can be complicated, but it is is not as difficult as navigating regular health insurance plans. We will simplify the types of dental insurances and explain them in simple terms below.
Types of Dental Insurance
There are four types of dental insurance available. 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.
Here is a good resource for learning more about various dental insurance terminologies.