When you are at work and receive a benefits package from your employer, one of the most common benefits of your comprehensive package is dental insurance. Typically, most organizations offer three different types of dental insurance plans. These plans are: direct reimbursements, dental DMOs and dental PPOs.
Deciding which of the three dental insurance plans is right for you may be difficult because you might not know exactly what they mean. You don't want to get signed up with dental insurance plans you don't know much about. Here are some brief descriptions of what you can expect when signing up with direct reimbursements, dental DMOs and dental PPOs.
Direct Reimbursement Plans
These dental insurance plans give you the freedom to choose any dentist you want. When you visit the dentist, you simply pay for the services rendered. You then fill out a claim form and submit it to your dental insurance administrator for direct reimbursement. There is usually a deductible you must meet prior to receiving payment for service. The plan will usually reimburse you a percentage of the total bill. You may receive anywhere from 50 to 80 percent from direct reimbursement dental insurance plans. There are no reasonable or customary limits with these dental insurance plans.
Dental DMOs
These dental insurance plans are much like HMOs (Health Maintenance Organization). These dental insurance plans offer a network of dentists to choose from. You can go to any of the dentists on the network and simply show your insurance identification card. The identification card lets the dentist know you are a member of the DMO (Dental Maintenance Organization). The dental office then files the claim on your behalf. Dental insurance plans, like DMOs, usually cover 100 percent preventative care. Preventative care includes routine check-ups and cleanings. For any other mouth work, these dental insurance plans usually cover 80 percent of the dentist's fees. You would then be required to pay the remaining 20 percent. Remember, you must visit the network of dentists to receive dental care and to have your benefits paid. Premiums are generally higher with these dental insurance plans because the coverage is more comprehensive. DMO dental insurance plans are typically the most popular.
Dental PPOs
This is a more flexible plan than a DMO, but not as flexible as the dental reimbursement plan. With PPO dental insurance plans, you can either use a network dentist or out-of-network dentist. If you choose to use the network dentist, you will receive a higher level of benefit. However, when you use an out-of-network dentist, you will pay the difference between the amount charged by the dentist and the reimbursement from the plan. There is no paperwork for you to fill out if you choose a network dentist. When going with an out-of-network dentist, you must file the claim and pay any difference between what the plan pays and what the dentist charges. There is usually a deductible with PPO dental insurance plans. The deductible must be met before any payment is made by the plan. Coverage is normally 100 percent for preventative care and anywhere from 50 to 80 percent for other services.
These dental insurance plans are typical when looking at your options for dental coverage. For any specific questions regarding which dental insurance plans are the best for you and/or your family, request more information from your employer or the insurance company providing the dental insurance plans.
John Ivie