What’s a covered benefit?
Treatment that is recommended by a dentist, and accepted under the terms of your group’s plan which can differ significantly between plans.
What’s the difference between indemnity, PPO, HMO, & discount insurance plans?
Indemnity or Traditional Insurance reimburses members or dentists at the dentist’s UCR (Usual, Customary & Reasonable fee). Typically the insurance will pay 100% of preventive services, such as cleanings and x-rays. They will usually pay 80% of work such as fillings and 50% for major work such as crowns and bridges. Typical yearly maximums are $1,000 to $2,000. This allows the subscriber to go to any dental office without being limited to a panel.
Preferred Provider Organizations provide members with a list of participating dentists from which to choose. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. They also assist with insurance billing. Most companies pay 50% on major treatment (crowns, bridges, partials), 80% for basic care (fillings), and up to 100% for preventative care (exams, x-rays, basic cleanings). Annual maximums generally range from $1,000 to $2,000.
Also known as capitated or prepaid insurance, was designed to provide members with basic care at the lowest rate. Participating providers receive a monthly capitation check for patients assigned to the office. HMOs generally don’t pay for services rendered. This type of insurance requires a patient to be assigned to a particular doctor.