These 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
- Free preventive or routine
- You must select from an
approved network of dentists
- May have an initial
- Annual dollar cap
- Your average monthly cost:
$25 to $45
- Companies selling these
plans are regulated by state insurance departments.
Finding the right value in dental
insurance or dental plans is an important step in purchasing dental
coverage for you and your family. Both types of dental plans have
advantages and disadvantages and one size does not fit everyone.
Keeping this in mind is an important
rule when you shop for the dental plan that best fits your needs. We
sell both individual and family dental insurance and dental discount
plans throughout all 50 states. Here are some brief examples that may
help you decide.
Indemnity - Dental Insurance
This is the plan where
you choose your own dentist. The dental insurance 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.
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
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.
You will want to use
caution with this type of dental plan since it 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
Learning About Dental PPO's
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:
Annual dollar cap
You must stay within the
approved network of dentists or pay higher deductibles and co-payments
Your average monthly cost:
Companies selling these
plans are regulated by state insurance departments.
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
Some typical features of a direct reimbursement plan:
Neither you nor your
employer pay monthly premiums
Freedom to choose any
Typical employer cost:
depends on the number of employees and
Benefits usually capped at
$500 to $2,000 annually.
Insurance - How Dental Benefits Help You
Individual Dental Insurance
Individual dental insurance is one of the most widely adopted
private insurance types...
Family Dental Insurance
Family dental insurance plan is a very great way to cover your
family, at reduced costs...
Dental Insurance Decisions
Dental decision is not an easy task when purchasing benefit
PPO Dental Insurance
Learning about Dental PPO's Preferred Provider Organizations -
another true insurance plan..
Dental Plan Coverage
Always review the dental plan coverage description thoroughly
for any variations in coverage...
Indemnity Dental Insurance
This is another plan where the plan pays the dentist on a
traditional fee-for-service basis...
DHMO refers to a dental health maintenance organization...
Business Dental Insurance
Business dental insurance plans have become essential to
Affordable Dental Insurance
Affordable dental insurance plans may have should not limit
the pool of dentist..
Dental Insurance for Braces
Cheap dental insurance for braces can be found through a
variety of insurers...
Supplement Dental Insurance
This dental plan will normally not cover the entire dental
Student Dental Insurance
Is one of the most affordable with special student
Benefits of Dental Insurance
Remember, benefits vary depending on the type of dental
Dental Insurance for Crowns
Dental crowns are also useful for patients who tend to grind
Cosmetic Dentistry - Insurance
A popular cosmetic dental procedures to a perfect smile is
Best Dental Insurance Plans
Discusses the analysis of dental care needs in order to find
the best dental insurance for you...
Types of Dental Insurance
Dental insurance is intended to help offset the costs
associated with dental care...
Insurance - Important Dental Care Information
Wisdom teeth are a
valuable asset to the mouth when they are healthy...
Although tooth decay
has declined among young children as a group problems
law mandates that consumers with dental coverage receive a
Choosing a Dentist
Dental benefits plans can be categorized by the
options offered for selecting a dentist. Some
plans allow you the freedom to choose your own dentist...
Paying the Dentist
When choosing a benefits plan, it
is important to know who pays what to whom. Dental plans can
be categorized into three types based on the compensation and
All Dental Plans have their Limitations
Today's health insurance, including your
dental plan, is designed to help you get the care you need at
a reasonable cost. Because
each person's oral health is different, costs can vary widely.
To control dental treatment costs...
To help contain costs, your plan may limit your
benefits by number of procedures and/or dollar amount in a
given year. In most cases, particularly if you've been getting
regular preventive care, these
limitations allow for adequate coverage...
Getting the Most out of Your Dental Plan
To take full advantage of your
dental benefits plan, visit the dentist regularly and get
the preventive care that will keep your mouth healthy...