Our agency is very active in the group dental insurance marketplace. Whether you are investigating dental insurance for a group plan, or a partially self-funded multi-state corporate group plan, our agency is prepared to assist you. We can help you evaluate your needs, survey the marketplace, prepare plan and price comparisons for your review, and then help you implement the plan(s) you determine best meet your objectives.
How does dental insurance work?
Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or "premium"), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.
What is a dental PPO plan?
Dental PPO (Preferred Provider Organization) plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan the patient typically obtains care through a network of dental providers who agree to serve the plan's members at reduced rates. When you use a network provider, you will typically pay a certain percentage (e.g. 20%) of the reduced rate, and the insurance company will pay the remaining percentage (e.g. 80%).
As a member of a Dental PPO plan, you may use dentists outside of the Dental PPO plan network, but you will typically only be reimbursed based on the amount that a network dentist would have accepted as payment in full. The rest of the total charges will be considered the patient's responsibility.
What is the difference between an in-network and an out-of-network dentist?
An in-network dentist is one contracted with the dental insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network dentist is not contracted with the insurance company. Typically, if you visit a dentist within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network dentist. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from non-network dentists.
As a general rule, Dental PPO (and other managed care) plans utilize provider networks. Dental Indemnity plans typically do not utilize a network of providers.
