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Group Dental Insurance

Dental Insurance is amongst the most popular type of employee benefits offered by employers. It can be instrumental to help recruit and keep high quality employees. The needs of many people whom require multiple visits to the dentist throughout the year raise the popularity of dental insurance. Additionally, many employers realize that dental coverage goes hand in hand with employee health insurance and can be a key component of the employee benefit package at a much lower cost than group health.

If you are considering dental insurance for you business you can be assured Group Coverage, Inc. can find the best group dental insurance to fit your company’s specific needs.

DHMO - Dental Health Maintenance Organization

A dental health maintenance organization is occasionally referred to as a capitation dental insurance plan. It is a type of insurance where a group of dentists, or a single dentist, joins in a contract with the DHMO to offer dental treatment for the patients who are a part of the DHMO. The organization pays the dentist a certain amount per patients per month who are enrolled in the group. However, some carriers may implement a fee-for-service basis in which the dentist is paid for the services rendered, rather than a fixed amount per patient. Sometimes, if the contract specifies, the patient pays a co-payment for certain treatments while paying nothing for standard treatments such as exams and cleanings. In Addition, there are usually no claim forms. In a DHMO, the patients must visit only dentists that are part of the DHMO network.

Dental EPO - Exclusive Provider Organization

An exclusive provider organization is a network of dentists that are united with the insurance company to provide care at a reduced cost. In return, the EPO pays most of the cost of the patron’s dental care needs. An EPO is a closed dental plan, so customers can only visit the dentists that are in the plan so it differs from the PPO in that regard. Generally, an EPO does not pay the dentists until services have been rendered for the customers.

Dental POS - Point of Service

A Dental point-of-service (POS) plan permits a member to use either a DHMO/DMO network dentist or to seek care from a dentist not in the DHMO/DMO network. Members decide in-network care or out-of-network care at the time they make their dental appointment and typically incur higher out-of-pocket costs for out-of-network care. Out-of-network care can be subject to deductible, co-insurance, usual and customary fees, and benefit limitations.

Dental PPO - Preferred Provider Organization

A preferred provider organization dental plan is dental coverage that is part of a network insurance system. Dentists sign up for the PPO network hoping to acquire more patients. The dentists offer lower rates for the clients of a particular dental insurance carrier, in return for the referrals the insurance company provides. Patients have the choice of choosing from a network of specific dentists, or seek dental care out of the network. However, choosing out-of-network care may result in higher fees or decreased benefits.

By William F. Schaake, CIC, CRM, CLCS  © 2007

Understanding Dental Insurance Plans

Selecting the Right Plan

There are many types of dental insurance products such as DHMO’s, PPO's, and indemnity plans. Understanding the complex nature of these plans and how the coverage's affect the group requires a certain level of expertise. In addition, adapting the plans to the needs of the members requires a human approach, one that is derived from years of experience based on the feedback obtained from other clients. We never sell our products solely based on price unless cost is paramount to the group. We examine all aspects of the group needs, such as the network of providers, the coverage's offered, the reputation of the carrier, and the value to the group. Our dedicated trained representatives take great pride in their product knowledge and their ability to customize a package appropriate to the organization. To understand the basics of some various types of plans, the following is a list of the most popular types and a brief explanation of the various plans and terms:

Dental - Indemnity Plan

An indemnity dental insurance plan is often called a traditional dental coverage plan or a fee for service plan. In this particular type of dental insurance plan, you have the choice to visit any dentist or dental care professional you wish. Generally, you do not need to select your dentist from a list of network providers or approved providers to qualify for benefits and coverage.

Normally, you will need to pay a deductible on your indemnity dental insurance. Once the deductible has been satisfied, the insurance carrier will cover a portion of “usual and customary” dental costs. How much your dental insurance will reimburse will differ according to the carrier. However, many insurance carriers offering this type of plan could possibly pay up to 100% of usual and customary dental costs.

Dental services will usually fall into one of four types. Occasionally implantology will fall into a fifth category. Here is a list of the four types and some examples of what falls into their respective categories:

          Type I (Diagnostic and Preventative)

          Type II (Basic)


          Type III (Major)

Type IV (Orthodontics)

Popular Dental Carriers

Individual Dental Plans:    HealthPlex Dental      DentalPlans.com

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