Insurer

Dental Insurance

What are Dental PPO, POS, and DHMO?
A Dental PPO (Preferred Provider Organization) provides dental care to its members through a network of dentists who offer discounted fees to its plan members. You can typically use dentists out of the PPO’s network, but you will only be reimbursed the discounted fee for the services rendered - you will need to pay any additional amount yourself.

A DHMO (Dental Health Maintenance Organization) provides you dental services through a network of providers in exchange for some form of prepayment. If you use a dentist out of the established network of providers, you may be responsible for paying the entire bill.

A Dental POS (Point of Service) plan allows a member to use either a DHMO network dentist or to seek care from a dentist not in the HMO network. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care.

What are Indemnity Plan?
An indemnity plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any dentist. You do not need referrals or authorizations; however, some plans may require you to pre-certify for certain procedures. Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of “usual and customary” charges for covered services. Many dental indemnity plans also require a waiting period before covering certain services.

What is a deductible?
A deductible is the amount of annual dental expenses that a dental plan member must pay before the plan will begin to cover expenses. For example, if your plan has a $50 deductible, you will pay the first $50 of your dental expenses before your dental plan begins paying the expenses. Only expenses for covered services apply towards the deductible. For example, if you paid $1,000 for orthodontic work that was not an expense covered by the plan, then the $1,000 will not apply toward your annual deductible.