What Is Dental Insurance?

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.