|
Understanding
Dental
Benefits
Dental
benefits
offer
a
great
deal
of
flexibility
in
terms
of
the
types
of
services
that
are
covered
and
the
types
of
plans
that
are
available,
and
it's
important
to
understand
all
the
options
available
before
choosing
a
plan.
Coverage
for
Dental
Services
Preventive
Care
covers
routine
checkups,
including
services
and
procedures
used
to
prevent
tooth
decay
and
other
oral
diseases.
Basic
Restorative
Care
covers
common
restorative
services
including
fillings,
procedures
to
restore
damaged
teeth
and
repair
dentures,
bridges,
crowns
and
inlays.
Major
Restorative
Care
covers
major
dental
procedures
including
the
replacement
of
missing
natural
teeth
with
dentures
or
bridges,
and
the
repair
of
severely
decayed
or
fractured
teeth
with
crowns.
Most
carriers
provide
coverage
for
preventive
and
basic
restorative
services
to
encourage
members
to
receive
the
regular
care
needed
to
maintain
good
dental
health.
Coverage
for
major
restorative
services,
as
well
as
riders
for
orthodontic
care
and
dental
implants,
are
generally
optional.
Types
of
Dental
Plans
Dental
plans,
like
medical
plans,
can
be
structured
in
any
number
of
ways.
However,
the
preferred
provider
organization
(PPO),
dental
health
maintenance
organization
and
the
fee-for-service
are
the
most
common.
Preferred
Provider
Organization
(PPO):
Network
providers
agree
to
a
negotiated
fee
schedule
as
payment
for
their
services,
and
members
are
offered
financial
incentives
to
use
dentists
who
participate
in
the
network.
Patients
may
choose
to
receive
services
from
any
dentist
but
will
receive
the
highest
level
of
benefits
by
selecting
a
PPO
dentist.
In
some
cases,
providers
must
adhere
to
quality
and
utilization
controls.
Dental
Health
Maintenance
Organization
(DHMO):
Members
prepay
for
comprehensive
dental
benefits
through
their
premiums
and
co-payments,
and
receive
care
through
a
limited
network
of
dentists.
Dental
HMOs
generally
provide
coverage
for
all
basic
care
and
complex
care
without
deductible
or
maximums,
reduce
members'
out-of-pocket
costs
and
limit
paperwork.
Some
HMO
plans
utilize
a
system
known
as
capitation.
In
capitated
plans,
providers
accept
a
monthly
fee
per
subscriber
(and
their
family,
if
applicable).
Member
co-payments
are
accepted
as
payment
in
full
for
all
covered
services.
Fee-for-Service/Indemnity
Plan:
Members
receive
care
from
the
dentist
of
their
choice,
and
dentists'
charges
are
based
on
a
fee
for
each
service
performed.
Some
dental
programs
have
contracts
with
dentists
who
agree
to
accept
a
predetermined
fee
as
payment
for
services.
Back to Top
|
