As part of a comprehensive benefits package, more and more employers are offering dental plans to their employees.

Similar to group medical, in an attempt to control costs, network plans have proliferated over recent years. Unlike medical care, dental services tend to be high in frequency, but rather low in cost. 

Generally, types of group dental plans include the following:

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

Conventional and PPO plans
The plan deductibles is satisfied (typically $50 annually) the insurance carrier reimburses the member’s expenses depending on the type of care 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

To continue our “typical plan scenario” Diagnostic and Preventive care is paid at 100% and not subject to the annual deductible – this is to encourage regular check-ups and to avoid minor problems from becoming major. Basic services are generally reimbursed at 80% and Major services at 50% - both subject to deductible while Orthodontic care is often 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 “capped” at anywhere from $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.

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.

Dental Maintenance Organizations
(DMOs – also referred to as “pre-paid dental plans”) are similar conceptually to medical HMOs.  That is, 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:
California Dental Association (CDA) - Consumer's Guide to Dental Insurance