Dental Health Insurance Key Terms

Sink your teeth into the vocabulary of dental health insurance

If you're considering offering your employees dental health coverage, you may want to familiarize yourself with dental health insurance key terms. Dental health insurance offers many types of plans, such as discount dental plans, indemnity plans, capitation programs and schedule-of-allowance programs. There also are other dental health insurance key terms, such as predetermination of costs and annual benefits limitations. Taking the time to get to know many of these terms won't leave you down in the mouth when it comes time to research dental health insurance.

 

Dental indemnity plan

Often referred to as traditional dental health insurance coverage, dental indemnity plans allow participants to visit any dentist of their choice. While deductibles apply, there are many benefits to dental indemnity plans, such as 100 percent coverage for preventive care, no required referrals and higher insurance payments for "usual and customary" charges.
Try: DentalInsuranceHelper.com provides a detailed explanation of dental indemnity plans, including how they work, what they do and don't cover, and the advantages and disadvantages of this type of program.

Dental discount plan

In a dental discount plan, participants visit a dentist who has agreed to offer services for a discounted price. From cleanings to dental X-rays, dentists contract to perform dental services at a pre-arranged cost. There are no deductibles, waiting periods or uncovered pre-existing conditions.
Try: Find a detailed description of how dental discount plans work at Dental Related Internet Resources.

Capitation dental plan

A capitation dental plan is essentially a dental health maintenance organization (HMO). Under this plan, a dentist contracts to offer pre-determined dental services to participants and is paid a monthly amount regardless of the services provided to each individual participant.
Try: Animated-Teeth.com offers a thorough description of capitation dental plans, including the good and bad points of this program.

Direct reimbursement

A direct reimbursement dental health insurance plan reimburses participants on the amount they spend on any dental service rather than covering the type of service performed. As with indemnity plans, participants can go to the dentist of their choice.
Try: Allinsuranceinfo.org gives a full explanation of direct reimbursement dental health insurance plans.

Usual, customary and reasonable (UCR)

In dental health insurance, usual, customary and reasonable (UCR) is used to determine how much of the cost of a dental service an insurance company will agree to pay. This is usually a percentage of a "usual and customary" amount determined by the insurance company. UCR figures vary from one company to another and there is no federal regulation of these fees.
Try: The American Dental Association (ADA) has a brief, but informative, description of usual, customary and reasonable (UCR) in regard to dental health insurance.

Schedule of allowance

In schedule-of-allowance dental health insurance plans, a list of allowable dental services and fees is followed. The fee may or may not reflect the dentist's charge for any particular service. Any difference between the allowable fee and the dentist's charge is paid by the participant.
Try: You'll find a detailed definition of schedule of allowance under the heading Calculating Payments at the Web site of the California Dental Association.

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