Kinds of Dental Insurance Plans
Managed Care Dental Plans
Preferred Provider Organization (PPO) plans are plans in which the patient has to select a dentist from a list provided to him. These dentists have agreed to discount their fee by contract with the insurance company. Some PPO plans also allow patients treated by dentists outside their list, where the patient is penalized by excess co-payments and higher deductibles. PPO’s are normally less expensive than indemnity plans in their class.
Keep the following in mind while reviewing a PPO Dental Insurance Plan.
What is the percentage of the premium used for administration?
Will the discount influence patients to change their regular dentist?
Will the amount ofthe discount the dentist ahs to offer affect the number of treatment options for the patient?
What is the liability of the employer in the event of the plan influencing dentist selection or treatment?
What are the criteria of selection of dentists for the plan?
Does it have adequate number of dentists under contract?
What is the geographic distribution of dentists?
Does the PPO dental insurance plan provide for specialist referrals?
If so, are the dentists limited to a specialist on the “list” only?
How does the plan provide for emergency treatment?
If so then how does the plan provide for emergencies outside the geographical area?
Dental Health Maintenance Organization (DHMO) or Capitation plans are designed in such a way that the patient does not have any financial payout when he goes for treatment.
These plans pay the dentists on their “list” a fixed amount of money monthly per enrolled family or individual, regardless of visits. In return, the dentists provide specific types of treatment to the patients who visit him at no charge, any other types of treatments require co-payment.
This way, the DHMO is rewarding dentists to keep patients in good health, thereby keeping the costs low. This kind of plan is one of the least expensive.