Question 1

What's a covered benefit?

Accepted Answer

Treatment that is recommended by a dentist, is listed on the fee schedule, and accepted under the terms of your group's plan.

Question 2

What's optional treatment?

Accepted Answer

Treatment that is either not listed on your fee schedule or more than the minimum to restore the tooth back to its original function.

Question 3

What's the difference between indemnity, PPO, HMO, & discount insurance plans?"

Accepted Answer

Indemnity or Traditional Insurance reimburses members or dentists at the dentist's UCR (Usual, Customary & Reasonable fee). This allows the subscriber to go to any dental office without being limited to a panel.

Question 4

What is PPO (Preferred Provider Organization)?

Accepted Answer

PPO is the most common form of insurance. They provide members with a list of participating dentists to choose from. The dentists on this list have agreed to a lower fee schedule, which provides you with greater cost savings. They also assist with insurance billing. Most companies pay 50% on major treatment (crowns, bridges, partials), 80% for basic care (fillings), and up to 100% for preventative care (exams, x-rays, basic cleanings). Annual maximums generally range from $1,000 to $2,000.

Question 5

What is HMO?

Accepted Answer

Also known as capitated or prepaid insurance, was designed to provide members with basic care at the lowest rate. Participating providers receive a monthly capitation check for patients assigned to the office. This amount is only a few dollars and is intended to offset the administrative costs. HMOs generally don't pay for services rendered. Fees are usually greatly reduced, but the patient is solely responsible for paying the doctor.