Preventive: These benefits consist of cleanings, X-rays, etc. These benefits are usually covered at 100% depending on the plan design. Please see your benefits guide for specifics to your carrier's plan.
Basic Coverage: These benefits consist of simple fillings, extractions. Please see your benefits guide for specifics to your carrier's plan. These services are usually covered from 75-80% depending on the plan design.
Major: These benefits consist of Root Canals, Crowns and Bridges.
Orthodontia: These benefits consist of braces. Age limits for these services are usually 19.
Dental plans usually have the following components:
Deductibles: The number of covered expenses that the insured must pay before the plan or insurance contract starts to pay claims for covered benefits.
: Most policies require the insured to pay some portion of the bills. A typical arrangement is after the deductible is meant that the insurer pays a portion and the insured pays a portion depending on the class of services up to a set maximum for example of covered expenses. After the maximum out of pocket limit is met the insurer pays 100% for covered services for the remainder of that calendar year up to the benefit amount or lifetime maximum.
Plan Maximums: These can vary from $750 per person to $2500 per person depending on the coverage.
Dental Coverage can be any of the following:
Indemnity: The insurance company will pay the provider and there is no network you must go through. Most costly coverage because of no network.
Passive PPO: You receive more of a discount if you go to an in-network provider but is not required. It will pay like an indemnity plan but the reimbursement may be a little less.
PPO: You must go to an in-network provider to receive the in-network benefits to avoid less coverage.
Individuals can purchase this coverage but few carriers sell individual products.