Frequently Asked Questions - Dental Insurance
- Where are the other dental insurance plans that I am familiar with?
Some dental health insurance providers (such as Delta Dental and Aetna) only provide dental coverage to businesses or groups, rather than to individuals and families.
Back to Top - What's the difference between Dental insurance and Discount Cards with dental discounts?
In addition to dental insurance, we carry Discount Cards that provide discounts for dental care. Although these cards are not a form of insurance, they will provide you with discounts for dental services when you visit a participating dentist.
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Key Differences
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Dental Insurance
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Discount Cards with Dental Discounts
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Who pays for services
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You pay monthly premiums, deductible and co-pay/coinsurance (see below); the insurance company pays dentist directly for remainder of charges.
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You must pay the dentist directly at the time dental services are rendered. The Discount Card does not pay any money to the provider. You also pay a monthly membership fee to the discount program in exchange for discounted rates at participating dental providers.
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Discounted Rates at Selected Providers
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PPO plans have pre-negotiated discounted rates with selected providers.
Indemnity plans allow you to see any dentist, and, as such, do not have discounted rates at selected providers.
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Offers discounted rates at participating dental providers.
Note: Can be used in conjunction with Dental Insurance Indemnity plans.
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Deductible
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Typically has a deductible, i.e., insurance company may not start paying for services until your dental expenses reach a certain dollar amount.
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No deductible - Discounts are available at first visit to dentist.
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Co-Pay/Coinsurance
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After deductible is met, you may need to pay a nominal amount (e.g., $10) per office visit or a percentage (e.g. 20%) of the cost of a larger procedure. Insurance company typically pays for remainder of charges.
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Not applicable - For a given service, participating dentists will charge you the contracted discounted rate that has been pre-negotiated.
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Waiting Period
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Many dental insurance plans require you to be a policyholder for 6 to 18 months before paying for major dental services.
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Not applicable - Since no waiting periods apply.
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Annual Maximum Benefit
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Most dental insurance plans will only cover up to certain amount per member per year (e.g., $1,000). After that cap is reached, you are responsible for all dental expenses.
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Not applicable - You and your family members can use your discount program membership as often as you need.
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Back to Top - What is the difference between and in-network and an out-of-network dentist?
An in-network dentist is one contracted with the dental insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network dentist is not contracted with the insurance company. Typically, if you visit a dentist within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network dentist. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from non-network dentists.
As a general rule, Dental PPO (and other managed care) plans utilize provider networks. Dental Indemnity plans typically do not utilize a network of providers.
Back to Top - How can I insure just my child?
When getting quotes for your child(ren) only, enter the child's gender and birth date in the "Applicant" or first row. Additional children should be entered below in the "Child" rows, but not the "Spouse" row.
However, many health insurance companies require one policy per child. So if you have more than one child, try entering just one child to see a larger selection of plans and prices. You are free to apply for each child separately.
Back to Top - What is a Dental Indemnity plan?
Dental Indemnity plan is commonly known as a fee-for-service or traditional plan. If you select an Indemnity plan you'll likely have the freedom to visit any dentist you wish. You typically will not be required to obtain referrals; however, some plans may require you to obtain preauthorization for certain procedures. Most Dental Indemnity plans require you to pay a deductible. After you have paid your deductible, Indemnity policies typically pay a percentage of "usual, customary and reasonable (UCR) rates" for covered services. For instance, the insurance company may pay 80% and you may be required to cover the remaining 20% of the UCR.
Back to Top - What is a Dental PPO plan?
Dental PPO (Preferred Provider Organization) plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan the patient typically obtains care through a network of dental providers who agree to serve the plan's members at reduced rates. When you use a network provider, you will typically pay a certain percentage (e.g. 20%) of the reduced rate, and the insurance company will pay the remaining percentage (e.g. 80%).
As a member of a Dental PPO plan, you may use dentists outside of the Dental PPO plan network, but you will typically only be reimbursed based on the amount that a network dentist would have accepted as payment in full. The rest of the total charges will be considered the patient's responsibility.
Back to Top - What is the best dental insurance plan for me?
Although there is no one "best" dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you'll have to pay monthly for your coverage and how much you'll have to pay when dental services are rendered. Some plans will require that you pay a certain co-payment for services, or meet a specific deductible before the dental insurance company begins payment. Other plans may limit coverage to a specific dollar-amount maximum per year.
When reviewing your dental insurance options, here are a few questions to ask yourself:
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How much will it cost me on a monthly basis?
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Will I be required to meet a deductible? Once the deductible is met, how much will the dental insurance provider pay for my services?
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What dentists participate in the plan's network? Are these dentists that my family and I would like to see?
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If I used a dentist outside the plan's network, how much will I have to pay?
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Are there waiting periods for certain procedures?
Back to Top - What kinds of dental insurance plans are available?
Like health insurance plans, dental insurance plans are usually categorized as either Indemnity or managed-care plans (Dental PPO plans fit in this latter category). Put broadly, the major differences concern choice of dental care providers, out-of-pocket costs and how bills are paid. Typically, Indemnity plans offer a broader selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).
Managed-care plans typically maintain dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed-care dental plan and a broader choice of dentists with an Indemnity plan.
Back to Top - How does dental insurance work?
Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or "premium"), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.
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