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Dental Insurance


How does dental insurance work?

Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or "premium"), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.

What is a Dental PPO?

Dental PPO (Preferred Provider Organization or Participating Provider Organization) plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan the patient typically obtains care through a network of dental providers who agree to serve the plan's members at reduced rates. When you use a network provider, you will typically pay a certain percentage (e.g. 20%) of the reduced rate, and the insurance company will pay the remaining percentage (e.g. 80%).

As a member of a Dental PPO plan, you may use dentists outside of the Dental PPO plan network, but you will typically only be reimbursed based on the amount that a network dentist would have accepted as payment in full. The rest of the total charges will be considered the patient's responsibility.

What is a Dental HMO Plan?

HMO dental insurance plans typically require that members obtain services only from a select group of dental providers in order to be covered. Dental HMO plans may sometimes offer less expensive monthly premiums, but may also allow you less freedom to choose your own dentist.


What's the difference between Dental insurance and Discount Cards with dental discounts?

In addition to dental insurance, we carry Discount Cards that provide discounts for dental care. Although these cards are not a form of insurance, they will provide you with discounts for dental services when you visit a participating dentist.


Key Differences

Dental Insurance

Discount Cards with Dental Discounts

Who pays for services

You pay monthly premiums, deductible and co-pay/coinsurance (see below); the insurance company pays dentist directly for remainder of charges.

You must pay the dentist directly at the time dental services are rendered. The Discount Card does not pay any money to the provider. You also pay a monthly membership fee to the discount program in exchange for discounted rates at participating dental providers.

Discounted Rates at Selected Providers

PPO plans have pre-negotiated discounted rates with selected providers.

 

Indemnity plans allow you to see any dentist, and, as such, do not have discounted rates at selected providers.

Offers discounted rates at participating dental providers.

 

Note: Can be used in conjunction with Dental Insurance Indemnity plans.

Deductible

Typically has a deductible, i.e., insurance company may not start paying for services until your dental expenses reach a certain dollar amount.

No deductible - Discounts are available at first visit to dentist.

Co-Pay/Coinsurance

After deductible is met, you may need to pay a nominal amount (e.g., $10) per office visit or a percentage (e.g. 20%) of the cost of a larger procedure. Insurance company typically pays for remainder of charges.

Not applicable - For a given service, participating dentists will charge you the contracted discounted rate that has been pre-negotiated.

Waiting Period

Many dental insurance plans require you to be a policyholder for 6 to 18 months before paying for major dental services.

Not applicable - Since no waiting periods apply.

Annual Maximum Benefit

Most dental insurance plans will only cover up to certain amount per member per year (e.g., $1,000). After that cap is reached, you are responsible for all dental expenses.

Not applicable - You and your family members can use your discount program membership as often as you need.


 


 





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