How to use a dental INSURANCE Plan

No, this is not an insurance plan. This plan provides you with discounted prices on a wide range of services; you will pay for services at the discounted price at the time services are received.

Dental insurance plans are designed to financially assist you in the cost of dental treatment needed as the result of dental disease or accidents. As with medical policies, you pay a monthly rate or premium and are entitled to a certain level of benefits. Plan provisions and benefit amounts can vary from plan to plan, but most dental plans have a yearly maximum payout, deductibles (usually waived on preventive services), and waiting periods for major services such as tooth replacements. Covered services are classified as:

• Diagnostic –examinations, x-rays
• Preventive – cleanings and examination,
• Basic – fillings, root canal treatment, extractions
• Major – crowns, bridges, dentures

Your financial responsibility can vary depending on the benefit level assigned to a particular service. For example, a filling, which is considered a basic service, may be payable at 80% of the dentist’s fee, leaving you with a copayment of 20%. Whereas, the benefits for a major service (denture or crown) may be paid at a 50%, leaving you with a larger portion of the cost.

Some dental insurance plans can be purchased with orthodontia benefits, but cosmetic services are considered non-covered services in most plans.

Typically, dental insurance plans are categorized as indemnity plans (fee-for-service), Preferred Provider Organizations (PPO) and managed-care plans (Dental HMOs.) The main difference in these plans is premium cost, choice of provider, out-of-pocket expenses, and whether you are obligated to pay the dentist up front before receiving your reimbursement from the insurance company.

With an indemnity plan, you can choose any provider and the insurance company will issue a benefit payment based on the service and the dentist’s fee. If your plan is a PPO, you will need to choose a dentist from the plan’s dental network if you want to have a higher level of benefit paid and a lower copayment. This is because participating dentists have contracted with the insurance company to accept a reduced fee. As a member of a DHMO, you are required to enroll in the office of a participating provider for all necessary dental treatment. Your premiums and copayments will be lower than other plan types, but you will not have benefits if the treatment is done outside of your assigned office.

A dental discount plan is not considered dental insurance, so there are no yearly maximums, deductibles, excluded services, or waiting periods for major services. You pay an affordable, monthly membership fee, and when you see a network dentist who accepts the plan, you save between 5% and 50% for all dental treatment, including orthodontia and cosmetic procedures. No claim forms need to be filed, but you are required to show your membership card and pay your liability at the time of service. For instance, if you had a procedure done for $100 and the discount is 50%, you will owe $50 that day. A dental discount plan can be use along with a traditional dental plan to further reduce your out-of-pocket expenses.

A Preferred Provider Organization (PPO) is a plan that offers its members the use of a provider network that has contracted with the insurance company to accept reduced fees. As a member of a PPO, if you choose to have treatment done by a participating dentist, you will usually have a higher level of benefits paid, and your copayment will be based on the reduced fee.

A dentist’s normal fee for a procedure, for example, may be $100, but as a network dentist treating a plan member, he or she may have agreed to have the benefits based on a contracted amount of $80. If the benefit is paid at 80%, you will have a copayment of $16. If the treatment done by an out-of-network dentist, you will still receive benefits, but they may be paid at a lower percentage, and you will be responsible to pay the dentist the difference based on his or her usual fee.  So, if the $100 procedure was paid at a reduced level of 60%, your copayment will be $40 rather than $16.

A dental indemnity plan is what many people refer to as a traditional dental insurance plan or a fee-for-service plan. As a member, you can choose to go to any general dentist or specialist without affecting your benefit payment. The insurance company will base its payment on whichever is lower — the dentist’s fee or a usual, customary and reasonable (UCR) amount formulated for your geographic area. You are responsible to pay the difference between whatever the insurance pays and the dentist’s full fee. With this type of plan, many dentists require that you pay them at the time of service and have the insurance payment go directly to you.

A dental HMO is a managed-care plan that requires you to enroll in a participating office. This dentist becomes your primary office, where all treatment must be done in order for you to have coverage. If you need to see a specialist, your primary dentist is will do the referral for you, and you will be referred to a specialist who is part of the  dental HMO network. This type of plan typically has lower premiums than other plans and your copayments may also be lower.   

A Dental Network Plan is any plan that utilizes a network of participating dentists, who have contracted to provide treatment to plan members at discounted fees.  These plans are also called or discount dental plans or savings plans.

In-network dentists have negotiated and contracted with the insurance company to accept a reduced fee when treating plan members. In-network dentists are usually a part of dental PPO, dental discount plan, or other managed-care program, and if you are insured by one of these programs, you will most often have a higher level of benefits paid and less out-of-pocket expense when your treatment done by an in-network dentist.  

An out-of-network dentist has not negotiated any special reduced rates with any insurance company and is free to charge his or her usual fees, regardless of the patient’s insurance status.

Just as with medical plans, dental plans with high benefit levels and low out-of-pocket costs come with higher premiums. So, before deciding which dental plan to purchase, you may want to evaluate your dental needs. For example, if you are in good dental health and usually only need to see a dentist for routine checkups and cleanings, you may not need a plan with a high annual maximum or higher benefit levels for major services. However, a higher premium plan with richer benefits may be cost effective if you are in need of significant dental treatment.

Here are some questions that you may want consider before deciding on the best dental plan for you.

• How much will my monthly premium cost?
• Does the plan have a yearly deductible to meet, and on what services is the deductible applied?
• What is the yearly plan maximum?
• What is the level of benefit payments for various services?
• What services have a waiting period?
• Will I be required to use a dentist from the network?
• Are there network dentists in my area?
• What is the difference in my cost if I use a dentist outside of the network?

If you would like a quote for your child or multiple children, enter the child’s name on the “Applicant” row, with additional children entered in the rows below, which are designated for children. Don’t enter any children’s names in the row assigned to a spouse.  

Some insurance companies require a separate policy for each child, so you may want to enter just one child to see a larger selection of plans and premiums. And you can always apply for each child separately.

Because dental insurance rates are filed with and regulated by each state’s Department of Insurance, you will pay the same monthly rates, whether you purchase your plan through My Generation Benefits or the dental insurance company.

We believe that outstanding customer service is vital in helping you find a dental plan that is the best fit for you and your family. Licensed health insurance agents and knowledgeable representatives are always available to answer your questions and explain your various plan options.

• Call us at 888-327-8880 Monday through Friday 8:30 a.m. – 4:40 p.m. CST

• Use the blue contact/chat form on the bottom left corner of your screen.