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© 2016 by W E Shaw & Associates, LLC.

 

Group Dental Insurance

Many employees believe that group dental insurance is one of the must have employee coverages. Group dental may be provided by the employer, partially paid for by the employer and is also available on a purely voluntary basis in which the premiums are fully paid by the employee.

 

There are several types of group dental plans:

 

Preferred Provider Organization (PPO) – Through a PPO plan, each individual selects their dentist from a network of dental providers who have agreed by contract to reduce their fees. As a result of this fee agreement, PPO plans are generally less expensive than indmnity plans. Individuals are allowed to obtain treatment from dentists outside of the PPO (out-of-network or non-participating dentists). Services provided by out-of-network providers, however, are generally subject to higher deductibles and/or co-payments that are paid by the individual.

 

Dental Health Maintenance Organization (DMHO) – Typically the least expensive type of plan. All services are provided by professional dentists who agree to provide specific treatments and services to patients at no charge. Some services, however, may require a co-payment.

 

Indemnity Plan – Indemnity plans typically allow the patient to go to the dentist of their choice. These plans generally pay a portion of the dentist’s fee or a set dollar amount (usually, whichever is less). Payments may be made to the insured member or, by assignment, directly to the dentist. If there is a difference between the amount paid and the dentist’s full charge and the amount paid, the individual is generally responsible for the difference.

 

Scheduled Benefit Plan - A scheduled benefit plan reimburses the insured for a specific amount based on a fee schedule. Any additional amount charged by the provider is the responsibility of the insured. For example, if the insurance reimburses $47 for a cleaning, and the dentist charges $60 for a cleaning, the insured would be responsible for the difference of $13.