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Some plans require your dental practice to be part of a network, others limit maximum charges and many have set fees for specific services. A PPO plan is regular indemnity insurance combined with a network of dentists under contract to the insurance company to deliver specified services for set fees and according to the provisions of the contract. Contracted dentists must usually accept the maximum allowable fee as dictated by the plan, but non-contracted dentists may have fees either higher or lower than the plan allowance.
Dentists must then provide certain contracted services at no-cost or reduced cost to those patients. The plan usually does not reimburse the dentist or patient for individual services and therefore patients must generally receive treatment at a contracted office in order to receive a benefit. In this type of plan, an insurance company pays claims based on the procedures performed, usually as a percentage of the charges.
Generally an indemnity plan allows patients to choose their own dentists, but it may also be paired with a PPO. Benefits in this type of plan are based on dollars spent, rather than on the type of treatment. Direct Reimbursement is a self-funded plan that allows patients to go to the dentist of their choice. Depending on the plan, the patient pays the dentist directly or the benefit may be directly assigned to the dental office and then submits a paid receipt or proof of treatment.
The administrator then reimburses the employee a percentage of the dental care costs. With some plans there are no insurance claim forms to complete and no administrative processing to be done by the dental office or an insurance company.
Discount or referral plans are technically not insurance plans. If you like a lot of options and few requirements, a Dental Indemnity plan may be right for you. DEPO plans give you options to choose between seeing general dentists and specialists.
You don't need to choose a primary care dentist and you don't need referrals to see specialists. With a DEPO plan, you must see dentists in the network to be covered. Out-of-network coverage may apply for some types of dental emergencies. Like a DPPO, you are free to see dentists outside the network, but your costs will be lowest when you stay in-network.
Like a DHMO, you are required to choose a primary care dentist who will provide any needed referrals to specialists, in or outside the network, as you choose. This kind of freedom may mean you have a higher deductible, plan premium, and copays, depending on the plan.
If you don't really intend to see dentists outside your network, a DHMO may offer better cost savings. Orthodontic care, such as braces and other teeth-straightening services, can be expensive and not all dental plans provide coverage for braces.
When exploring types of dental insurance for orthodontic care , consider the following:. When you're shopping for a dental plan, look for those with coverage for major restorative care. This kind of dental care usually covers crowns, bridges, and dentures.
Check the plan annual maximum. This is the most your plan will pay for covered services in a plan year. If you reach that limit, you will be responsible for paying any and all additional costs for your dental care. If you expect to need more restorative care, a dental plan that has a higher annual maximum and more coverage for restorative care may be right for you.
Not all dental plans have a waiting period. A waiting period is the time between the date your plan is effective and the date you are covered to receive dental care.
There may be a waiting period for basic care versus major restorative care. This means you may be able to get a filling done sooner and be covered, but have to wait longer if you need something like a crown or bridge. Some plans may waive waiting periods if you had previous coverage with them.
Dental plans can vary a lot depending on the insurance carrier and plan design. When you're comparing types of dental plans, you might want to consider the kind of dental care you expect to need. Do you only need cleanings or routine exams? Or may you need fillings, or orthodontic services as well? Make sure you understand the details of plan coverage before making a final decision on the type of dental insurance that's right for you.
This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. All rights reserved. All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.
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Find a Doctor. Types of Dental Insurance Understanding the main differences between the types of dental insurance can help when choosing the plan that's right for you. When shopping for dental insurance and choosing a plan, you will want to know the following: Is there a deductible and coinsurance?
Are you required to choose a primary care dentist? Are you required to see dentists within a certain network to be covered? What are the different types of dental insurance? Need dental coverage?
Box Lexington, KY We will mail you your membership ID card and a detailed information packet. Your coverage will be effective the first of the month following receipt of application, if received by the 20th of the month.
Use the link below to review your dental benefits and related costs and access the appropriate application:. To find a participating dentist near you, you may access our Find a Doctor tool. For additional information, contact us Monday through Thursday from 8 a. Get a Quote. Skip Navigation.
Login Register. Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. Expand All Collapse All Overview. Select Plan Options. Coverage for Dependent Children Dependent children, up to age 26, can be added to a dental plan.
Payment Options Pay for your plan annually or quarterly. Apply To Enroll. Two easy ways to enroll! Dental Insurance Plan Basics. A guide to dental pre-treatment estimates: how to identify which procedures apply, how to submit for the pre-treatment estimate, and how to request payment once services have been approved and rendered. Submitting Claims for Dental Providers. Specialty topics and courses dedicated to our Dental healthcare delivery partners.
Featured Course. What are fee schedules Access requirements to view fee schedules Searching fee schedules by commonly billed procedure codes Searching fee schedules by a procedure code search How to view PDF results.
Take this module for need-to-know information! Dental Basics. Information located on ID cards Connecting logos with products National Network product information Dental Insurance Plan Basics Guide 10 minutes All Dental Providers A guide to dental pre-treatment estimates: how to identify which procedures apply, how to submit for the pre-treatment estimate, and how to request payment once services have been approved and rendered.
Submitting Claims for Dental Providers Self-paced Module 15 minutes All Dental Providers All about dental claims submission procedures and how to get help if you need it.
Claim submission requirements Electronic and paper claim submission Pre-treatment estimate submissions How to follow up on your submissions.
To find a participating dentist near you, you may access our Find a Doctor tool. For additional information, contact us Monday through Thursday from 8 a.
Get a Quote. Skip Navigation. Login Register. Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. Expand All Collapse All Overview. Select Plan Options. Coverage for Dependent Children Dependent children, up to age 26, can be added to a dental plan. Payment Options Pay for your plan annually or quarterly. Apply To Enroll. Two easy ways to enroll!
Apply online here. Download and complete the appropriate enrollment application. Plan Resources. Contact Us. Looking for need-to-know information about CareFirst Dental? Learn all about the different dental plans you may encounter, as well as answers to frequently asked questions! Expand All Collapse All. CareFirst Direct for Dental Providers. Eligibility and Benefits in CareFirst Direct.
Need help locating eligibility and benefits information on CareFirst Direct? This guide is for you! Claim Status in CareFirst Direct.
Accessing Remittance in CareFirst Direct. User Management in CareFirst Direct. Fee Schedules in CareFirst Direct.