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Benefits of Dental Insurance |
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Dental Insurance helps you pay the costs associated with dental care. Employers and other plan sponsors offer dental benefits for a variety of reasons, including promotion of oral health and attraction and retention of high-quality employees.
Almost all dental benefit plans are administered by a contract between the plan sponsor (usually an employer or a union) and the third party (usually an insurance company).
Limitations in coverage are the result of the financial commitment the plan sponsor has agreed to make and the benefits the third-party payer will offer in exchange for that commitment.
Treatment decisions must be made by the insured and the dentist. It is common for dental plans to exclude treatment that is covered under the company's medical plan. Whether the plan covers all the dental needs of the insured's family should be the prime concern and a crucial factor when choosing a plan.
The most common types of dental plans are:
- Direct Reimbursement programs reimburse patients a percentage of the dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patients to go to the dentist of their choice.
- "Usual, Customary and Reasonable" (UCR) programs usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit, whichever is less.
- Table or Schedule of Allowance programs determine a list of covered services with an assigned dollar amount. That dollar amount represents how much the plan will pay for those services that are covered. Most often, it does not represent the dentist's full charge for those services. The patient pays the difference.
- Preferred Provider Organization (PPO) programs are plans under which contracting dentists agree to discount their fees as a financial incentive for patients to select their practices. If the patient's dentist of choice does not participate in the plan, the patient will have a reduction or complete loss of benefits.
- Capitation programs pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge (for some treatments there may be a patient copayment). The capitation premium that is paid may differ greatly from the amount the plan provides for the patient's actual dental care.
- A Dental Health Maintenance Organization is another dental insurance plan option, based on the model of medical health Maintenance Organizations. Here the patient is enrolled in a program, and can visit any dentist in that program. However, dentists may end up having to provide services at 'below cost' rates, and not be able to spend as much time with each person as a PPO could offer.
This article was contributed by Prerna Mordani.
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