What are the different types of dental benefits products? 

There are four key types of dental benefit products with significant market shares today, i.e. dental HMOs, dental PPOs, dental Indemnity plans, and discount dental plans. Today 82% of all dental policies are DPPOs.

A common set of definitions is helpful in seeking dental benefits coverage. The terms we use are defined below:

Dental HMOs --refers to dental benefit plans that provide comprehensive dental benefits to a defined population of enrollees in exchange for a fixed monthly premium and pays for general dentistry services primarily under capitation arrangements with a contracted network of dentists. Enrollees must use network dentists to obtain coverage except where a point of service provision allows them to opt out of the network but at reduced coverage.

Dental PPOs --refers to dental benefit plans that have contracts with providers for the express purpose of obtaining a discount from overall fees. Enrollees receive value from these discounts when using contracted providers but may go outside the network of discounted providers but with a reduction in coverage. Providers are reimbursed on a fee-for-service basis after care is provided at either the discounted rate or the “UCR” (usual, customary, reasonable) rate recognized by the plan. Individuals are not balance billed for the difference between the negotiated fee and the actual fee that the dentist charges.

Dental Indemnity Plans--refers to benefit plans where the risk for claims incurred is transferred from employer to a third-party insurer for a specified premium and providers are reimbursed on a fee-for-service basis and there are no discounted provider contract arrangements whereby the provider agrees to accept a fee below their customary fee.

Discount Dental or Dental Savings Plans –refers to non-insured programs in which a panel of dentists agrees to perform services for enrollees at a specified discounted price, or discount off their usual charge. No payment is made by the referral plan to the dentists; dentists are paid the negotiated fee directly by the enrollee. These plans are sometimes referred to as “access plans,” “savings plans” or “discount plans.” 

What do dental plans normally cover?   arrow-right

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