Types of Dental Insurance

There are several basic types of dental insurance plans offering a range of cover from the most basic dental care plans to complete all encompassing dental insurance plans.

Basic dental care plans aren’t effectively an insurance but rather a ‘club’ that enables you to obtain discounted dental care from participating dentists. The level of discount is largely dependent on the monthly fee you pay but unlike dental insurance there is no limit to the amount of discounted treatment you can receive. One thing to check with dental care plans is the amount of local dental coverage (if any!). You can join a dental care plan for just a few dollars a month.

Indemnity Insurance Plans are a type of dental insurance whereby you pay the insurance company a fixed monthly fee who, in turn, will reimburse your dentist for services rendered. However, the dental insurance company doesn’t normally cover the whole cost with the policy holder be liable for 20 – 50% of the total cost. If you take out an indemnity plan you need to check the level of deductibles and the maximum amount the insurance policy will pay out in any given year. Also find out the length of any probationary period during which the dental insurance company won’t pay out and whether you are able to use your own dentist. Expect to pay around $14 to $26 per month.

One of the increasingly popular dental insurances is the direct reimbursement plans which are self funded by employer’s rather them paying dental insurance premiums. As a general rule the person receiving the dental care will pay the fee in full and reclaim all or part of the cost (depending on what level of cover their particular employer provides) from their employer. Annual benefits of this dental insurance option are usually capped with the capped level varying quite significantly from one employer to another

Capitation dental insurance plans (HMO’s) are when the dentist is paid an annual fee per patient rather than on a treatment basis. However, the dental insurance policy holder may be required to contribute towards the cost of any treatment. The cost of HMO insurance plans are generally targeted at preventative and emergency care and can vary from patient to patient following an initial examination.

Preferred provider organisations (PPO) offer an insurance plan that allows you to visit dentists from a preferred supplier list at a heavily discounted rate. If you choose to use a dentist that is not covered by the dental plan you will still receive some element of discount but nowhere near as much as you will receive from a ‘preferred’ dentist. As with most dental insurance plans an annual cap will apply. Expect to pay up to about $25 per month.

UCR (Usual, Customary & Reasonable) indemnity dental insurance plans have a database which contains average prices for each dental procedure you might undergo. When you submit your bill for payment the dental insurance provider will check the cost of your treatment against the average. If you paid more than the average you will have to incur the additional cost with the insurance company only paying the insured percentage of the fee shown in their database. If the cost of your treatment is lower than average you will receive the agreed percentage of the amount you paid. There is no control over how dental insurance companies calculate the UCR cost and the insurance company always pockets the benefit of lower fees.