Chapter 12. Dental Insurance Chapter Recap

DENTAL PLANS

Types of Dental Treatment

Types of Dental Treatment

• Diagnostic and preventive

• Restorative

• Oral surgery

• Endodontics

• Periodontics

• Prosthodontics

• Orthodontics

INDEMNITY PLANS

Scheduled vs. Nonscheduled Plans

Benefit Categories

Deductibles and Coinsurance

Combination Plans

Exclusions

Pediatric Dental Coverage

Scheduled vs. Nonscheduled Plans

• Scheduled:
  - Benefits are paid from a list of procedures
  - No coinsurance or deductibles (first-dollar benefits)

• Nonscheduled:
  - Pay on customary basis
  - Subject to deductible and coinsurance
  - Diagnostic, basic services, major services

Benefit Categories

• Diagnostic/preventive

• Basic services

• Major services

Deductibles and Coinsurance

• Deductible amounts of $25, $50, $100

• Met each calendar year

• Typically do not apply to preventive care

Combination Plans

• Combination of basic and comprehensive

• Cover diagnostic and preventive services

• Fee for other dental services

Exclusions

• Cosmetic surgery (excluding result of accident)

• Denture replacement or duplicates

• Oral hygiene instruction

• Workers compensation covered injuries

• Government agency provided services

Pediatric Dental Coverage

• Essential benefit of Affordable Care Act for children 18 years of age or younger

• Available on qualified health plan, stand-alone plan, or contracted/bundled plan