- Managed Care Plans
This type of coverage works to control costs associated with dental treatment and is typically provided by a network of professionals.
Management Care Policies can be further broken down into more specific programs:
Exclusive Provider Organization (EPO) – EPO plans, which only offer services from a select few dental care providers is the most restrictive dental plan option.
Preferred Provider Organization (PPO) – PPO plans are provided by a network of dental care specialists who are contracted by an insurance company and who offer discounted services in order to be a part of the preferred provider network.
Health Maintenance Organization (HMO) – Also known as a capitation plan, HMO’s are provided by a network of dentists that receive a specific amount for each participant of the plan in exchange for providing the necessary dental treatments required over the membership term.
- Traditional or Indemnity Policies
Unlike Managed Care Plans, Traditional Policies allow you to choose your own care provider, receive individual services at a set fee and then submit claim forms to receive reimbursements according to the terms of the policy. Coverage for each procedure can be partial or full depending on the features of the plan.
The cost of benefits for either type of policy are usually determined by using either a fixed-fee Table of Allowances or a percentage-based Usual, Customary or Reasonable (UCR) Fee Schedule.
In order to find the right dental plan for you and your family, you should ask the following important questions:
– What does the plan cover? Are preventative, diagnostic and emergency services included?
– Can I select my own dental care provider or are there restrictions?
– How are decisions made regarding the choice of treatment? Are they stipulated by the dental plan, the dentist or do I have input?
– Are there any limitations or exclusions for the plan?
– Am I able to get referrals for specialists?
– Is there any waiting period before I can access certain benefits?
– Which members of my family are covered under the plan?
The answers will reveal your best options and help you make the right choice.