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DENTAL
INSURANCE PLAN HELP AND INFORMATION |
UNDERSTANDING THE BASICS OF DENTAL
INSURANCE
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Cleaning Your Teeth:
Replace your toothbrush
every three or four months or sooner if the bristles become
frayed. A worn toothbrush will not do a good job of
cleaning your teeth.
Children’s toothbrushes often need replacing more frequently
than adults because they can wear out sooner...
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Dental Sealants:
Dental
sealants act as a
barrier, protecting the teeth against decay-causing bacteria.
The sealants are usually applied to the chewing surfaces of
the back teeth (premolars and molars) where decay occurs most
often...
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Dentures:
If you’ve lost all of your
natural teeth, whether from periodontal disease, tooth decay
or injury, complete
dentures can replace your
missing teeth and your smile. Replacing missing teeth will
benefit your appearance and your health...
- Different
Dental Insurance Plans for Different Needs:
Consumers can choose from
an assortment of
dental benefits plans
that accommodate a variety of needs and expectations. The
following factors differentiate one plan from another...
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Dental
Health:
Based on information gathered
during the 2001 American Dental Association (ADA) annual
session,
dentists report that oral
bacteria, in some studies, have been associated with heart
disease, stroke, diabetes and the birth of pre-term, low-
birth- weight babies...
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These insurance plans, also known as "capitation plans," operate
like their medical HMO cousins. This
type of dental plan provides a comprehensive dental care to enrolled
patients through designated provider office (dentist). A Dental Health
Maintenance Organization (DHMO) is a common example of a capitation
plan.
The dentist is paid on a per
capita (per person) basis rather than for actual treatment provided.
Participating dentists receive a fixes monthly fee based on the number of
patients assigned to the office. In addition to premiums, client
co-payments may be required for each visit. Some typical features of these
plans:
- Monthly premiums (some
require you to prepay a year's worth)
- Co-payments for office
visits
- Free preventive or routine
care
- You must select from an
approved network of dentists
- May have an initial
enrollment fee
- Annual dollar cap
- Your average monthly cost:
$5 to $15
- Companies selling these
plans are regulated by state insurance departments. |
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Finding the right value in dental
insurance or dental plans is an important step in purchasing dental
coverage for you and your family. Both types of dental plans have
advantages and disadvantages and one size does not fit everyone.
Keeping this in mind is an important
rule when you shop for the dental plan that best fits your needs. We
sell both individual and family dental insurance and dental discount
plans throughout all 50 states. Here are some brief examples that may
help you decide.
Indemnity - Dental Insurance
This is the plan where
you choose your own dentist. The dental insurance plan pays the dental office (dentist) on a
traditional fee-for-service basis. A monthly premium is paid by the
client and/or the employer to an insurance company, which then
reimburses the dental office (dentist) for the services rendered.
An
insurance company usually pays between 50% - 80% of the dental office
(dentist) fees for a covered procedures; the remaining 20% - 50% is
paid by the client. These plans often have a pre-determined or set
deductible amount which varies from plan to plan. Indemnity plans also
can limit the amount of services covered within a given year and pay the
dentist based on a variety of fee schedules.
Some typical features of these plans:
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High deductibles before coverage
begins (well-designed plans don't apply the deductible to preventive
services)
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Probationary periods on certain
procedures that last up to a year
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Annual dollar limit on benefits
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Chose your own dentist
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Your average monthly cost: $15 to $25
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Companies selling these plans are
regulated by state insurance departments.
Dental Discount
You will want to use
caution with this type of dental plan since it is not insurance. The managing organizations have
negotiated with local dental offices to establish a set price for a
particular dental procedure and offer deep discounts (some up to 70%)
off the regular ADA pricing code.
This plan has several
advantages over traditional dental insurance plans, namely, there are no
exclusions for pre-existing conditions. This allows a patient to receive
immediate coverage for work without meeting any waiting period
requirements.
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Learning About Dental PPO's |
Preferred Provider Organizations
Another true insurance plan, a
Preferred provider organizations ( PPO) falls somewhere between an
indemnity plan and a dental HMO. This plan allows a particular group of
patients to receive dental care from a defined panel of dentists.
The participating dentist
agrees to charge less than usual fees to this specific patient base,
providing savings for the plan purchaser. If the patient chooses to see a
dentist who is not designated as a "preferred provider," that patient may
be required to pay a greater share of the fee-for-service.
A group of dentists agrees to provide services at a
deeply discounted rate, giving you substantial savings — as long as you
stay in their network. Unlike the more restrictive DHMO, though, you can
go out of network and still receive some benefits. Some typical features
of these plans:
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Monthly premiums
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Annual dollar cap
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You must stay within the
approved network of dentists or pay higher deductibles and co-payments
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Your average monthly cost:
$20-25
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Companies selling these
plans are regulated by state insurance departments.
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Direct Reimbursement Plans
A dental care plan now coming into vogue is the direct reimbursement plan.
This is a self-funded benefit plan — not insurance — in which an
employer pays for dental care with its own funds, rather than paying
premiums to an insurance company or third-party administrator. You, the
patient, pay the full amount directly to the dentist, then get a receipt
detailing services rendered and the cost, which you show to your employer.
The employer reimburses you for part or all of the dental costs, depending
on your specific benefits.
Your company might reimburse 100 percent of your first $100 of dental
expenses and then 80 percent of the next $500, and 50 percent of the next
$2,000, with a total annual maximum benefit of $1,500. Or it might
reimburse only 50 percent of your first $1,000, resulting in a $500 yearly
cap.
Some typical features of a direct reimbursement plan:
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Neither you nor your
employer pay monthly premiums
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Freedom to choose any
dentist
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Typical employer cost:
depends on the number of employees and
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benefit caps
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Benefits usually capped at
$500 to $2,000 annually.
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DENTAL
INSURANCE PLAN HELP AND INFORMATION |
UNDERSTANDING DENTAL
INSURANCE AND DISCOUNT DENTAL PLANS
.
DHMO Dental
Networks
.
Business Dental Plans
.
Affordable Dental Plans
.
PPO Dental Insurance
. Dental Plan Coverage
.
Indemnity Dental Insurance
.
Dental Plan Decisions
.
Individual Dental Insurance
. Family Dental Plan
. Best Dental Plans
. Getting Insurance for Braces
.
Supplemental Dental Insurance
.
Student Dental Insurance
.
Benefits of Dental Insurance
.
Dental Insurance for Crowns
.
Cosmetic Dentistry - Insurance
. Various Types of Dental Plans
UNDERSTANDING THE BASICS OF DENTAL
INSURANCE
- Wisdom
Teeth:
Wisdom teeth are a
valuable asset to the mouth when they are healthy and properly
positioned. Often, however, problems develop that require
their removal. When the jaw isn't large enough to accommodate
wisdom teeth...
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Tooth Decay:
Although
tooth decay
has declined among young children as a group, it can still be
a problem for individual children, and even teens and
adults...
- Making
Informed Choices: The
law mandates that consumers with dental coverage receive a
fully detailed patient
information handbook
-- a
Description of Benefits -- that clearly outlines coverage,
limitations and exclusions...
- Choosing
a Dentist: Dental benefits plans can be categorized by the
options offered for
selecting a dentist. Some
plans allow you the freedom to choose your own dentist...
- Paying
the Dentist:
When choosing a benefits plan, it
is important to know who pays what to whom. Dental plans can
be categorized into three types based on the
compensation and
treatment provided...
- All
Dental Plans have their Limitations:
Today's health insurance, including your
dental plan, is designed to help you get the care you need at
a
reasonable cost. Because
each person's oral health is different, costs can vary widely.
To control dental treatment costs...
- Annual
Benefits: To help contain costs, your plan may limit your
benefits by number of procedures and/or dollar amount in a
given year. In most cases, particularly if you've been getting
regular
preventive care, these
limitations allow for adequate coverage...
- Getting
the Most out of Your Dental Plan:
To take full advantage of your
dental benefits plan, visit the
dentist regularly and get
the preventive care that will keep your mouth healthy...
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