Dental Insurance Plan

Indemnity Dental Insurance Plan

Indemnity dental insurance is a fee-for-service plan. This means that you will submit your claim for the procedures done, and the insurance company will reimburse you for a percentage of the cost associated with that procedure. Usually, you will need to pay up front at the dentist’s office. The percentage of cost covered by a dental insurance plan varies from policy to policy, but the standard rate is 70%-80% of preventative dental care (exams, cleanings, X-rays etc). For more complex procedures such as crowns and bridgework, the plan may cover a lesser percentage of the cost or none at all. Cosmetic procedures, such as whitening and caps, are usually not covered by dental insurance plans.

Indemnity plans allows you the flexibility to seek treatment from your preferred provider. However, if you do not want to pay up front, you can opt for a managed dental care program. Managed care dental programs operate in much the same way as standard health insurance policies.

Types of Managed Dental Care

There are several types of managed dental care. Understanding these policies is the first step in making an informed decision.

DHMOs

With Dental Health Maintenance Organization plans (DHMOs), a certain group of dentists are contracted to provide dental care for the members of the plan. With this type of dental health insurance plan, dentists are paid a fixed amount of money no matter what type of procedure they perform. While more financially feasible for some, this plan does have its downfalls. The main concern is that if the cost of the procedure provided exceeds the DHMO fee that is paid out, dentists can make it difficult for DHMO members to receive quality care. If this is the case, some dentists will prioritize more profitable patients ahead of plan members. Another drawback is that the choice of dentists can be very limited. In extreme cases, you may be given a choice of one or two dental care facilities to select from.

PPOs

Preferred Provider Organization plans (PPOs), in contrast, offer you a wider selection of care providers to choose from. To be included in a PPO network, dentists must discount their fees for plan members. Whether you choose a dentist from inside or outside the network, you can count on a portion of the costs being covered. However, as with standard health insurance, your out-of-pocket costs will be lower if you choose a care provider within the plan.

EPOs

Exclusive Provider Organization plans (EPOs) are similar to PPOs, in that you are offered a choice of dentists to select from. However, it is important to note that there is absolutely no flexibility with regard to seeking care outside of the network.

Closed Vs. Open Dental Health Insurance Plans

Indemnity dental coverage is a type of insurance that utilizes an open panel of doctors. In contrast, DHMOs, PPOs and EPOs utilize a closed panel of doctors. With open panel health insurance, you can seek care from the doctor of your choice. With a closed panel policy, you are completely constrained by the network or financially penalized for seeking care outside the preferred range of doctors.

Most people select a managed care or closed panel dental health insurance plan for financial reasons. However, be sure to read the fine print before making your final decision. Carefully evaluate the plan and ask the following questions:

• Will I have access to dental care if an emergency occurs out-of-town?
• Is specialized care available if needed?
• Will I have access to orthodontists, periodontists and oral surgeons if expert care is required?
• What percentage of cost will be covered for specialized procedures?

Related Insurance Links

• Individual Dental Insurance
• Delta Dental Insurance
• Texas Dental Insurance or Plans
• Medical Insurance
• Guardian Dental Insurance
• Health Insurance Plan