Below, we cover those basics in regard to plan types, service categories, and coverage areas.
The 3 Main Types of Dental Insurance Plans
The first major type of dental plan is the “indemnity” plan. Under this system, the insurer will pay a pre-set percentage of your dental bill. However, that percentage may vary from procedure to procedure or even based on how long you’ve had the policy.
The second major type of dental insurance is the DHMO plan. DHMO stands for Dental Health Maintenance Organization, and its basic idea is that dentists pay a small fee to be in a network in exchange for giving a discount to policy-holders from the relevant insurer. With DHMO plans, you have to stay in-network to be covered.
Finally, the third major plan type is the PPO (Preferred Provider Network), which is very similar to the DHMO set-up. The main difference is you can still be covered if you get service out of network, albeit you won’t get as much coverage in that case.
The 7 Main Dental Insurance Service Categories
With almost any dental insurance policy, there will be seven standard service categories.
The first four, preventative care, restorative dentistry (as in fillings/crowns), endodontics (mostly root canals), and oral surgery (extractions and minor dental operations), are typically immediately covered when you opt into the policy. But you may have to own your policy for over a year, or even two or more years, before periodontal care (to do with gum health) and prosthodontic care (as in dentures/bridges), are also covered. The seventh category, orthodontics (braces, retainers, and the like) is normally an optional rider on your dental plan, which you can add at any time.
The 3 Basic Coverage Areas in Dental Insurance
Finally, note that the seven service categories are simplified into only three “coverage areas” on most dental policies. These are as follows:
1. Preventative Care
Preventive care includes dental check ups, teeth cleanings, oral exams, X-rays, and dental sealants. Most plans cover these sorts of services in full.
2. Basic Procedures
“Basic” dental procedures like a tooth extraction, a filling, a root canal, or the most common forms of periodontal treatment, may only be covered 60% to 80% on many plans or may require a copay.
3. Major Procedures
What is a “major” dental procedure? That could vary from insurer to insurer. But a dental crown, bridge work, an inlay, and dentures are often in this coverage area. Some policies place root canals in the “major” category, and some policies will cover dental implants as a major procedure as well.
There are many complex details to different dental insurance policies that you would have to go over with your insurer, but knowing the policy-types, service-categories, and coverage-areas will help you be a better dental insurance shopper.
To learn more about the ins and outs of how dental insurance works, contact Flagler County Insurance Agency today!