Dental Indemnity Insurance
With a dental insurance plan of the indemnity variety, you are free to visit and seek dental care from any dentist you wish. These sorts of insurance plans require deductibles to a larger and more expensive degree than DPPOs, but offer greater freedom in return.
Traditional coverage
Dental indemnity plans are regularly referred to as ‘traditional’ plans, due to the popularity and widespread usage of the model. In contrast to managed care options like DHMOs and DPPOs, which seek to reduce your financial costs at the expense of flexibility, indemnity plans guarantee absolute freedom of choice. You are not expected to select a dentist from a list of preferred in-network specialists in order to claim for coverage and other benefits.
What you pay
To qualify for coverage on indemnity plans, you must pay an agreed deductible fee each year. The deductible is the amount of money the insurer requires you to pay before they will contribute to sharing the cost of any treatment. When you have reached the ‘deductible’ figure, the insurer covers ‘usual and customary dental’ costs, usually paying a large portion of these expenses. Depending on the plan, they may pay between 80% and 100% of these costs. However, this also depends on the dentist you use and their prices. If a dentist charges more for a procedure than your insurer considers it to commonly cost, the insurer will consult their UCR fee schedule and calculate a lower portion to pay toward the costs.
Usual and Customary
It is also important to understand what your potential insurer means by ‘usual and customary’ costs. Most companies do not cover procedures which fall outside of this zone, so take careful notice of the fine print of any insurance policy so you are well informed about what is and isn’t covered. In general you can expect indemnity policies to cover up to 100% of preventative care (e.g. cleaning, check-ups), 80% of procedures involving minor restoration, and about 50% of more costly treatments like fillings or orthodontics. Major procedures may not be covered.
Annual Maximum Benefit
Also check any policy to see if they set a maximum benefit amount, and take note of what this figure is. This is an annual threshold, either for certain treatments or the entire year, that the insurer will not pay beyond; if you reach this figure then any further treatment in that same year may not be covered. The maximum benefit is reset each year.
Other features
With dental indemnity insurance, you do not need to obtain referrals or anybody’s permission before seeing a certain dentist. The freedom of this system means that filling out paperwork can be necessary, and it can be necessary to acquire pre-certification for some of the more in-depth and complex procedures. In that case the insurer asks to see claims and paperwork for them to review and analyse before they will cover the treatment. This is standard for major treatments, but people new to an indemnity policy might find that they need to wait a certain period before receiving full coverage.