Dental insurance
Usually offered only under group plans, due to adverse selection. Dental is not covered by most medical expense policies or by Medicare
Integrated vs non-integrated dental
Dental coverage may be written as a non-integrated (stand-alone) group dental policy or can be included as an optional coverage on a group medical expense policy, where the deductible amount could be met by either dental or medical expenses
Scheduled (basic) or non-scheduled (comprehensive) coverage
A nonscheduled plan pays claims on usual, customary and reasonable basis (UCR) based on average charges in
a specific geographic area. A scheduled plan contains specific categories of dental treatment and dollar amounts are set for each category of covere
Prosthodontics
The branch of dentistry dealing with the replacement of teeth and related mouth or jaw structures by artificial devices (bridgework)
Periodontics
The branch of dentistry dealing with diseases of the gums and other structures around the teeth
Endodontics
Specialty that deals with the diagnosis and treatment of diseases of dental pulp (internal teeth structure)
Orthodontics
Branch of dentistry concerned with irregularities of the teeth and bite; mechanical devices to straighten teeth, i.e.braces
Dental indemnity plans
Written by insurance companies to reimburse the insured for covered dental expenses
Basic (Scheduled) Plans
Similar to a basic medical expense plan, reimburses dental charges only up to the maximum amount specified on the schedule for each covered service. Basic plans have first dollar coverage, with no deductible or co-insurance and the
insurer will reimburse
Comprehensive (Non-scheduled) Plans
Very similar to Comprehensive Major Medical coverage,
benefits are subject to both calendar year deductibles and coinsurance requirements, although the deductible usually does not apply to preventative care, such as cleaning or routine examinations
Combination Plans
The features of both the Basic (Scheduled) Plans and the Comprehensive (Non-scheduled) Plans may be combined
Usual, customary, and reasonable
In indemnity plans, an amount paid for health care services by an insurance carrier based on a combination of the usual fee the individual physician charges for the service, the customary fee charged by most physicians in the community, and the reasonable
Dental plan limitations
Limitations may also apply to the number of preventative care visits allowed in a 12-month period (usually two), but there is no limit on the number of teeth needing treatment.
Prepaid dental plans
Operate in much the same manner as HMOs. They offer services based on capitation, or fixed per member per month payments where the dental plan assumes the full risk for the
cost of services without regard to type or frequency. Such plans are not considere