Affordable Dental Coverage from

Considerations in Choosing a Dental Plan
Information to help you, from

Dental Plan Descriptions
Indemnity (Open Panel) Dental Plan
Pre-selected Dental Plan
Managed Care Dental Plan (HMO)
Managed Care Dental Plan (PPO)
Self-Funded Insurance Dental Plan (Direct Reimbursement)

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Here's the drill on choosing a dental plan
Small Business Savvy
Mie-Yun Lee

Fixing your dental problems can be a painful experience. But choosing a dental plan for your company or yourself should not be. There are five parts of every dental plan that you need to compare in order to make a fair evaluation.

Most importantly, take a look at the services that are covered. While one plan may cover orthodontia, another plan may not provide coverage for it at all. Similarly, while one plan may offer coverage of 80 percent of preventative care costs, another may cover the full amount.

Carefully examining the list of coverage exclusions and limitations can help ensure that you and/or your employees do not run into any surprises when it comes to submitting claims.

Do not be fooled by percentages. While a dental plan may indicate that it will cover a set percentage of your costs, you and/or your employee may have to pay substantially more than the remaining percentage. This is because a UCR program, which is one of the most common dental plan structures, provides reimbursement for a treatment based on either the actual incurred dental charges or the "usual, customary and reasonable" costs that the dental plan determines are typical.

The dental plan will then provide reimbursement based on the lower, less costly amount. To assess how reasonable a dental plan's limits are, it can be useful to compare the UCR allowances across plans for a set of routine treatments such as a cleaning, a filling, a set of X-rays or a root canal.

Dental plans can also differ in terms of which dentists they are willing to reimburse. While you can always go to any dentist that you would like, you may not always get reimbursed for your treatments equally. Dental plans can either choose to accept all dentists or be more restrictive and limit reimbursement to certain dentists only. If your company is small enough, it can be a wise move to check the list of participating dentists for a given plan before agreeing to sign up.

Also, do not overlook the administrative requirements for maintaining the dental plan. Find out what flexibility you have in adding or terminating employees. Some dental plans are very restrictive and require the company to notify the plan immediately about any changes it would like to make. If this window is missed, you risk having an employee who cannot obtain coverage until the next open enrollment.

Alternatively, you may potentially waste money by having to pay for coverage for an employee who no longer works with your company if you do not report the termination in a timely fashion.

How much does a dental plan cost? Dental plan insurance rates can range from $5 to $100 a month, depending on whether you see the coverage as an individual or for a family and according to how generous the coverage is. Rates will also be lower if your company has 50 or more employees so you can qualify for group discounts. For a free quote for dental insurance, go to

While the temptation may be great, avoid making a decision based on cost alone. With the right plan in place, you and/or your employees can keep smiling.

Mie-Yun Lee is editorial director of BuyerZone (, a virtual purchasing adviser for small businesses, and author of "The Essential Business Buyer's Guide." Call 800-938-0088 for more information.

Affordable Dental Coverage from

Insurance Plans and Descriptions

Open Panel (Indemnity dental plan)

  • allows choice of dental office
  • insurance company & you each pay percentage of fees
  • dentist reimbursed based on fee schedule
  • wide variety of plans available
  • encourages prevention

Managed Care dental plan (HMO)

  • prepaid plan with specific network of dental offices
  • treatment overseen by HMO
  • dentist reimbursed less than usual & customary fees
  • co-payment often required


Managed Care dental plan (PPO)

  • choice of either dental offices within or outside network listed
  • more treatment options
  • dentist reimbursed based on negotiated fee schedule
  • co-payment often required


Self-Funded Insurance dental plan (Direct Reimbursement)

  • allows choice of dental office
  • employer directly reimburses you a predetermined amount
  • employer/company sponsored
  • simple and easy to use
  • you & dentist play active role in your treatment and oral health


When you choose a dental insurance plan, you're also choosing a type or category of plan with its approach to the provision of benefits and payment for dental care services. For example, the indemnity plan allows you to chose any dentist, while the pre-selected dentist plan requires you to select and always use the same contracted dentist. Call the carrier's member services if you have a specific question.

When comparing plans, check premiums and benefits to predict your possible costs for the balance of the plan year. You only pay deductibles if you use benefits through the dental plan, and co-pays (Indemnity only) and out-of-pocket expenses.

Once enrolled, review all the materials that are sent to you so that you understand the terms and conditions before using the dental plan services. Should you have any issues at any time throughout the year, contact your carrier's member services department. They are there to serve you.


Considerations for enrolling in an Indemnity Dental Plan
An Indemnity plan pays established benefits when you seek covered services from any licensed dental provider, not just from among those in a contracted status with the carrier.

There is an annual deductible, then the plan will pay a percentage of covered charges; and you'll pay the balance. If the provider bills more than the plan allows, you will be responsible for any charge over the plan's allowed amount for each procedure code.

We have an additional benefit with our indemnity dental plans. It includes the benefit that you will not be charged a higher amount than that which the carrier says is usual, customary and reasonable, provided you use one of their contracted, preferred providers (PPO). Benefits will be paid at 80% or 50% of usual, customary and reasonable charges, subject to the yearly or lifetime limit depending upon each procedure.

Considerations for enrolling in a Pre-selected Dentist Plan
These plans require you to select a dentist from a list of contracted dentists. You must always use that dentist for your entire dental needs. You may change your primary dentist during the plan year, by selecting another dentist from the list and then notifying the dental plan's member services office. If your selected dentist determines that you need to see a specialist, then the services required will be covered as specified in the plan booklet.

The plan booklet lists your out-of-pocket expenses for any required procedure. The charges are reduced fees. That is, a reduction in what would other wise be charged.

The majority of dentists who contract with these plans require that you be on their patient roster, before a appointment can be scheduled. The plans update rosters on a monthly basis. However, if you are new to a plan, or change dentists, and not on your selected dentist's roster, and have a dental emergency, you can call the plan's member services office for referral to a dentist.

Dental insurance is designed as a financial assistance for your dental needs. Insurance should not determine your dental care and treatment. For example, you may require 3-4 cleans per year to control tooth decay or gum disease. Insurance may pay for only two appointments. You will need to contribute financially to maintain optimum oral health. Be informed.


Dental Insurance Selection and Use

Can you choose your dental office or must you choose from a list? Are you allowed to see specialists and how many are available on your plan? How many providers in your area? Are there co-payments for many services? Ask and Compare.

Remember - insurance coverage is just a partial assistance toward good oral health.

Know your benefits - read your policy and compare.

Know your options - limitations and exclusions of your dental plan.

Practice good oral hygiene- follow the advice of your registered dental hygienist and dentist.

Provide feedback- let others know of your experiences.

Ask questions- be interested and involved in your own health. Ask for option alternatives at your insurance renewal.

Maintain Good Oral Health

Most dental plans provide coverage for selected diagnostic services, preventive care and emergency treatment. These services are basic for maintaining good oral health. However, depending on your dental plan, the extent or frequency of the services covered may be limited.

You may be required to pay the dentist directly for a portion of the basic care, depending upon your individual oral health needs. Good dental health is worth the investment.

Every dental care plan is different. Familiarize yourself of the benefits of your dental plan to maximize your coverage. During the negotiation and/or renewal of your coverage, ask about different options and alternatives for your insurance package.

Remember - the registered dental hygienist is an important part of your dental visit.

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