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Dental

Employers may offer group dental plans to their employees as part of a comprehensive benefits package. Unlike medical care, dental services tend to be high in frequency, but lower in cost. 

Generally, group dental plans include:

  • Conventional (Indemnity) plans
  • Dental Preferred Provider Organizations (PPOs)
  • Dental Maintenance Organizations (DMOs)

Conventional and PPO Plans

Conventional and PPO plans allow members to receive care from any licensed provider. However, a PPO member will receive a higher level of benefit if they receive care from a network provider.

After the plan’s deductible (typically $50 annually) is satisfied, the insurance carrier reimburses the member's expenses depending on the type of services provided. Typically dental services are categorized into:

  • Diagnostic and Preventive - exams, cleanings and diagnostic x-rays
  • Basic Services - restorative care (fillings and extractions)
  • Major Services - crowns, bridges and dentures
  • Orthodontic Care

Diagnostic and preventive care is typically paid at 100% and not subject to the annual deductible. This is to encourage regular check-ups and to avoid a minor problem from becoming major. Basic services are generally reimbursed at 80%, and major services at 50%. Both are subject to a deductible. Orthodontic care is typically reimbursed at 50%. Non-network covered benefits are subject to a "reasonable and customary" amount for services rendered in a geographic area.

Annual benefits are typically "capped" between $1,000 to $2,000 for diagnostic/ preventive, basic and major services. Because of its nature, Orthodontic care is subject to a lifetime maximum (typically from $1,000 to $2,000), and can be offered to children and/or adults.

Dental Maintenance Organizations (DMOs)

DMOs, also referred to as "pre-paid dental plans," are similar conceptually to medical HMOs. To receive care, the member must choose services from a network provider.  Benefits typically are reimbursed based upon a published schedule. While low in cost, networks are limited in size, generally confined to metropolitan areas, and restrict care to network providers.

Additional Resources