Dental insurance is a type of health insurance designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three categories: indemnity, which allows you to see any dentist who accepts insurance, Preferred Provider Network (PPO), and Health Managed Organizations (DHMO). DHMO assigns and in-network dentist or dental office and requires that you stay within the network to receive benefits.
A dental office will have a fee schedule, or list of prices, for services and procedures they offer. Insurance companies have similar fee schedules which are based on Usual and Customary fees, or an average of fees in your area. When a dentist participates with an insurance company he/she agrees to match their fee schedule and give the patients a reduced cost for services. If you see an Out-of-Network or Non-Participating Provider the difference of fees will become the financial responsibility of the patient. Some insurance plans may have waiting periods. This is a period of time before certain benefits will be covered.
Most insurance plans have an annual maximum benefit. Once the annual benefit is exhausted and additional treatment is rendered, the fees incurred are the responsibility of the patient. Each year the annual maximum is reissued. Orthodontics usually has a spate limit. Most plans have and annual deductible. After the deductible is met, the remaining plan benefit is paid at its specified percentage.
Insurance companies divide benefits into categories in accordance with the American Dental Association. Basic, Preventive and Diagnostic, and Major procedures are covered at different percentages. Many insurance plans offer free semi-annual preventative treatment. This includes x-rays and cleanings (and fluorides for children).