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A Guide to Dental Insurance

This guide provides the facts to be aware of when considering dental insurance. Insurance plans deal mainly with treatments by general dentists, who are the main dental healthcare providers.
Specialist dental services are covered, depending on the plan.
The Choice of Plan
There are many dental insurance plans to choose from. It is important to know what treatments are included and excluded, and what the limits are on yearly payments for treatments.
Here are some facts and answers to be informed about:
Treatment cover
The treatments that are covered by the plan should be clearly stated.
They will usually include the preventive and general treatments by the general dentist. Specialist dental services should also be stated.
Decisions on treatments
Some plans limit the decisions on, and the treatments that dentists can provide. Others allow individual choice to the dentist and patient.
The Choice of Dentist
The choice of dentist may be confined to those that are contracted to your plan.
This is often the case in Capitation Plans detailed below.
The Cost of Insurance and The Cost of Treatment
The routine cost of treatment by the general dentist and the dental specialist are covered in various ways. Study the details and be sure about what treatments are included and those which are excluded. Each plan is different.
We briefly revue the Indemnity, Direct Reimbursement and Capitation Plans:
Indemnity Plan Details
Under this plan the patient makes a monthly payment to the insurer. The dentist is paid directly by the insurer.
The insurer pays only 50-80% of the cost of the treatment. The balance of the fee is payable by the patient. Limits are set.
Direct Reimbursement Plan Details
This is a flexible plan where the employer reimburses the patient with a proportion of the amount paid to the dentist. This is a fee-for-service dental plan. There is a freedom of choice arrangement under which a dentist is paid for each treatment according to the fee set by the dentist.
The patient has a choice of dentist. The dentist and patient can decide on the treatment.
Limits are set.


Capitation Plan Details
In this scheme the dentist is paid a flat fee for treating a certain number of patients. The more patients treated the higher the fee. The patient is obliged to attend at only the arranged dental practice. Seeking treatment elsewhere is costly, as it is not what is normally allowed.
This is more of a managed care plan. It is a cost containment system in which the degree of dental care is controlled by restricting the type, level and frequency of treatment.
The patient may be required to top up payments for each visit.
Limits are set.


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