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Dental Insurance Disclosure
All of
these dental plan types listed below may not be available in
New Jersey. If we are unable to offer a dental insurance plan, we will
provide a dental discount plan, if available, and clearly state it.
Please be sure to contact the plan dental office to confirm they are
accepting new patients and they are accepting the dental plan you have
selected. If you have any dental plan questions please feel free to
contact our office during
regular business hours. You will find our licensed insurance agents ready to
assist you.
Our dental web site is
very clear if you are selecting a dental insurance plan or a dental
discount plan. We understand that there are many dental plan web sites
popping-up all over the internet, claiming to offer "dental insurance"
when in fact they do not and are not licensed to offer a dental
insurance plan. If you find a site that says they offer dental
insurance, they are "required" to show their insurance license
information on the web site, as noted at the bottom of this page. If
they don't, then report them to your local state department of
insurance.
If you
find a dental web site stating they offer "dental insurance" and in
fact they don't, then take the opportunity to report that site to the
search engine you found them on.
Our
entire staff is licensed to offer, sell and service dental insurance.
Always ask to speak with a licensed insurance agent. Ask them if they
are licensed. Full disclosure is our guarantee...
Indemnity Plans
This type of dental plan pays the dental office (dentist) on a
traditional fee-for-service basis. A monthly premium is paid by the
client and/or the employer to an insurance company, which then
reimburses the dental office (dentist) for the services rendered. An
insurance company usually pays between 50% - 80% of the dental office
(dentist) fees for a covered procedures; the remaining 20% - 50% is
paid by the client. These plans often have a pre-determined or set
deductible amount which varies from plan to plan. Indemnity plans also
can limit the amount of services covered within a given year and pay the
dentist based on a variety of fee schedules.
Some typical features of these plans:
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High deductibles before coverage
begins (well-designed plans don't apply the deductible to preventive
services)
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Probationary periods on certain
procedures that last up to a year
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Annual dollar limit on benefits
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Chose your own dentist
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Your average monthly cost: $15 to $25
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Companies selling these plans are
regulated by state insurance departments.
Dental HMOs
These insurance plans, also known as "capitation plans," operate
like their medical HMO cousins. This
type of dental plan provides a comprehensive dental care to enrolled
patients through designated provider office (dentist). A Dental Health
Maintenance Organization (DHMO) is a common example of a capitation
plan. The dentist is paid on a per capita (per person) basis rather than
for actual treatment provided. Participating dentists receive a fixes
monthly fee based on the number of patients assigned to the office. In
addition to premiums, client co-payments may be required for each visit. Some
typical features of these plans:
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Monthly premiums (some
require you to prepay a year's worth)
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Co-payments for office
visits
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Free preventive or routine
care
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You must select from an
approved network of dentists
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May have an initial
enrollment fee
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Annual dollar cap
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Your average monthly cost:
$5 to $15
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Companies selling these
plans are regulated by state insurance departments.
Preferred Provider Organizations
Another true insurance plan, a
Preferred provider organizations ( PPO) falls somewhere between an indemnity
plan and a dental HMO. This plan allows a particular group of patients to receive dental care
from a defined panel of dentists. The participating dentist agrees to
charge less than usual fees to this specific patient base, providing
savings for the plan purchaser. If the patient chooses to see a dentist
who is not designated as a "preferred provider," that patient
may be required to pay a greater share of the fee-for-service. A group of dentists agrees to provide services at a
deeply discounted rate, giving you substantial savings — as long as you
stay in their network. Unlike the more restrictive DHMO, though, you can
go out of network and still receive some benefits. Some typical features
of these plans:
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Monthly premiums
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Annual dollar cap
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You must stay within the
approved network of dentists or pay higher deductibles and co-payments
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Your average monthly cost:
$20-25
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Companies selling these
plans are regulated by state insurance departments.
Dental Discount
This type of dental plan is not insurance. The managing organizations have
negotiated with local dental offices to establish a set price for a
particular dental procedure and offer deep discounts (some up to 70%)
off the regular ADA pricing code. This plan has several advantages over
traditional dental insurance plans, namely, there are no exclusions for
pre-existing conditions. This allows a patient to receive immediate
coverage for work without meeting any waiting period requirements.
Direct Reimbursement Plans
A dental care plan now coming into vogue is the direct reimbursement plan.
This is a self-funded benefit plan — not insurance — in which an
employer pays for dental care with its own funds, rather than paying
premiums to an insurance company or third-party administrator. You, the
patient, pay the full amount directly to the dentist, then get a receipt
detailing services rendered and the cost, which you show to your employer.
The employer reimburses you for part or all of the dental costs, depending
on your specific benefits.
Your company might reimburse 100 percent of your first $100 of dental
expenses and then 80 percent of the next $500, and 50 percent of the next
$2,000, with a total annual maximum benefit of $1,500. Or it might
reimburse only 50 percent of your first $1,000, resulting in a $500 yearly
cap.
Some typical features of a direct reimbursement plan:
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Neither you nor your
employer pay monthly premiums
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Freedom to choose any
dentist
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Typical employer cost:
depends on the number of employees and
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benefit caps
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Benefits usually capped at
$500 to $2,000 annually.
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