Diagnostic and Preventitive
an important feature of a dental insurance plan, which is typically not found in a medical expense insurance plan is the inclusion of diagnostic and preventive care. Most dental plans provide coverage for routine preventive procedures such as periodic tee
Restorative
restorative care means treatments, which restore functional use to natural teeth such as fillings or crowns
Oral surgery
oral surgery means operative treatment of the mouth such as extractions of teeth and related surgical treatment
Endodontics
treatment of the dental pulp within natural teeth such as a root canal
Periodontics
treatment of the surrounding and supporting tissue of the teeth such as treatment for gum disease
Prosthodontics
the replacement of missing teeth with artificial devices like bridgework or dentures
Orthodontics
treatment of natural teeth to prevent and/or correct dental anomalies with braces or appliances
Indemnity Plans
there are three diferent plans available. These plans consists of a scheduled or basic plan, a comprehensive or nonscheduled plan, and a combination of both basic and comprehensive plans
Choice of Providers
some dental plans limit the insured's choices of providers, but others simply limit the benefits to any qualified practitioner
Schedule Plans
basic or scheduled plans pay benefits from a list of procedures up to the amount shown in the schedule
Nonscheduled (comprehensive) plans
benefits are paid on a reasonable and customary basis and are subject to deductibles and coinsurance
Diagnostic/Preventive Services
generally are not subject to coinsurance or deductibles
basic services
fillings, oral surgery, periodontics, and endodontics may require the insured to pay a deductible of 20% of the balance
major services
inlays, crowns, dentures, and orthodontics, could either have large deductibles or pay around 50% for services provided
Deductibles and Coinsurance
most dental plans have a deductible amount such as $25, $50, or $100, which must be met each calendar year
Combination Plans
combine features of both basic and comprehensive plans
Exclusions
dental plans typically exclude cosmetic services (unless required by an accident), replacement of lost dentures, duplicate dentures, oral hygiene instruction, occupation injuries covered by Worker's Compensations, services provided by government agencies,
Limitations
to help keep costs down, dental plans provide more limitations than deductibles and copayments. Most plans provide for calendar year maximum benefits and lifetime maximum benefits. Routine exams and cleaning are generally limted to once every 6 months, fu
Predetermination of benefits
the predetermination of benefits (precertification or prior authorization) clause is found in most dental plans. This service, although generally not mandoatory, will allow the insured and the dentist to know in advance what benefits will be paid.