Group Dental Insurance

Most often group dental insurance is offered as part of an employee benefits package but there are companies that offer group plans at group rates to individuals as well. Unfortunately, there is some amount of misunderstanding behind group dental insurance and dental discount plans. Group dental insurance follows the established guidelines for insurance coverage while group discount plans are simply that, a discount on services provided to members of the plan. The most common types of group dental insurance plans are Dental Health Maintenance Organizations (DHMO), Indemnity Plans, Preferred Provider Plans (PPO) and Scheduled Benefit Plans.

DHMO vs. PPO Group Dental Insurance Plans
Most often DHMO and PPO group dental insurance plans are less expensive than Indemnity plans. In a DHMO group plan dentists provide services for specific treatments at no charge or with a small co-pay. Dentists who participate agree to help with preventative care in order to keep costs low and are paid directly through the insurance provider. The insured isn’t required to select a primary dentist with a DHMO plan but they must choose one with a PPO from a network of providers. Each of the dentists in a PPO provides services for reduced fees and while the insured is allowed to choose dentists outside the network, the savings will not be as great. These cost is based on a per service percentage which varies accordingly.

Indemnity Group Dental Insurance Plans
Unlike DHMO or PPO plans, the insured is allowed to go to the dentist of his or her choice. Indemnity plans have a set dollar amount for each and every service and if the dentist charges more than that the insured is required to pay that amount out-of-pocket. Payment is most often made to the dentist by the insured and then reimbursed from the dental plan. There are some indemnity plans that allow the insured to make an ‘assignment’ whereby the dentist is authorized to directly bill the insurance company on behalf of the patient which means no out-of-pocket expense at the time services are rendered. The dentist then agrees to bill the patient for any portion not covered by the insurance.

Group Dental Insurance Scheduled Benefit Plans
Scheduled benefit plans are very much like indemnity plans in that the insured pays for services at the time they are rendered and the insurance company then reimburses the insured up to a set amount for each visit. The insured will only be reimbursed the amount scheduled for specific services. As an example, if a routine office visit costs $125 and the scheduled benefit is only for $75 then the insured will only be reimbursed that amount. Since there are no network dental providers the insured can go to the dentist of his or her choice. All benefits are also based on a per calendar year maximum. For this reason, many people shop around for the lowest cost dentists so that the insurance will cover a greater portion of the bill.

While there are a number of dental plans on the market that offer discounted services through a group of dentists nationwide who agree to be providers under those plans, they are not strictly group dental insurance plans. Also, those types of plans actually cover less than traditional group dental plans. Where a group DHMO or PPO might cover from 80% to 100% of some dental services, a group discount plan will perhaps cover up to 50% of those same fees. For those individuals who aren’t covered by dental insurance at their places of employment or for the unemployed, a group discount plan may be a viable option but the best type of group dental insurance would be a traditional insurance plan.

Comments are closed.