What Is Dental Insurance?

Dental insurance is a type of health insurance that could help pay a portion or the full cost of the insured’s dental care. There are three categories of dental insurance for families, individuals, and group dental insurance plans. The categories are the Preferred Provider Network (PPO), Indemnity, and Dental Health Managed Organizations (DHMO).

We all know that dental jobs are so expensive nowadays — especially when you need to have minor and major surgery work done. If you do not have this insurance on your own, you have to pay the full cost of your dental care bills — that could probably make you broke in time. Here we will help you find dental plans that could surely suit your needs. Get a free quote here.

Dental Insurance

How Does Dental Insurance Payouts Work?

Generally, dental care providers have a list of prices for any dental services or procedures. On the other hand, dental insurance companies have similar fee schedules based on the average fees of procedure on the area. This fee schedule is used as a transactional instrument between the policyholder, dental care offices, and insurance providers.

Dental insurance carriers divide services or procedures and benefits into categories of coverage, including basic, preventive, and major. Usually, dental plans could cover the full cost of preventive dental services, such as cleaning. While for basic procedures such as extractions, root canals, and filings — most insurance providers could cover 70% up to 80% of these procedures. Lastly, for major procedures, such as crowns are can be covered — however, the insured has to pay a higher deductible and higher co-payment.

Limitations Of Dental Insurance

Other dental insurance plans may or may not have a yearly maximum limit of benefits. With this, once the annual maximum benefit exhaust — any succeeding dental treatments and procedures of the insured may become insured’s financial responsibility. Every end of the insurance plans, the policy can be renewed. The renewal of the policy may vary on the company’s fiscal year, and the calendar year. However, most companies based the renewal of the policy depending on their specific plans and enrollment date. Besides, this insurance does not cover cosmetic procedures, such as teeth whitening, veneers, and tooth shaping.

Dental Insurance

Types Of Coverages you should understand

With this coverage, the insurance providers technically pay for a percentage of the cost of the dentist’s service. However, there are certain restrictions for this coverage — including the waiting period, stated deductible, co-payment requirements, and annual limitations. Besides, there are also other restrictions like a graduated percentage scale that will be based on the type of procedure that will be done to the insured. At last, is the length of time of the dental insurance policy.

  • Waiting Period

This period is a particular time between when the action occurs and when the work is requested. The waiting period only means that if an incident occurs at this time, it is not claimable. For further illustration, suppose that the proposed insured had a toothache later on the afternoon of February 26th. He visits a dentist and advises him that he needed major periodontal surgery. However, this major surgery could cost him a thousand dollars. As a person, he then thought of how to save money, and then he remembers purchasing dental insurance. The next day, he purchased dental insurance and made a claim for his periodontal surgery. However, his claim has been denied; it is for the reason that if you buy dental insurance, there is a certain waiting period before the dental insurance works.

  • Deductible

The deductible is the amount that the policyholder has to pay before the insurance provider pays for any expenses.

 

This coverage plan entails that a dentist who is in contract with the insurance provider — has to agree to give their policyholder’s customer discounts as an In-Network Provider. Many Dental Health Maintenance Organization insurance plans typically have no waiting periods and no maximum benefit limitations. Additionally, this coverage is sometimes purchased by the insured due to its flexibility to defray an expensive dental procedure. Some dental insurance providers offer a free semi-annual preventative treatment — including the crowning of teeth and fillings. Besides, it can also cover the costs for dentures and teeth implants — but can be applied with various restrictions and limitations.

In California, this is also known as a Preferred Provider Organization. This organization is in sovereign authority by health care providers, health centers and medical doctors. This organization is following an agreement with an insurance provider — to provide people with a lower cost of dental treatment. Additionally, this coverage is for people that are associated with their clients. Participating Provider Network generally works as similar to DHMO while using an In-Network Provider. However, PPO could allow insured individuals to use services from Non-Participating or Out-of-Network Providers. Additionally, any difference between the fees and what the insurance would cover will happen as the insured’s financial responsibility, unless otherwise the fees are specified.

Direct reimbursement plans benefits would be based on the cost that was spent, rather than on the type of the procedure. This plan is a self-funded plan on which could allow the insured to appoint a dentist of their choice — even though it is an Out-of-Network Provider. Additionally, depending on the program, the insured could choose if the benefits will be paid to them so the patient could pay the dentist directly, or the benefit could be directly paid to the dental office. However, benefits may only apply if there is proof of official receipt transaction or evidence of treatment. Lastly, the insurance provider will then reimburse a percentage from the total amount of the dental procedure.

Exclusive Provider Organization plans require that the insured can only receive services from its participating dental care providers. This plan is limiting its subscribers from getting a service from the dentist of their choice. Besides, they are also limiting their subscribers from accessing care from other right dental care providers.