Dental benefits offer a great deal of flexibility in terms of the types of services that are covered and the types of plans that are available.
It is important to understand all the options available before selecting a plan. The primary services included in a dental plan are preventive care, basic restorative care and major restorative care. Preventive care covers routine checkups, such as services used to prevent tooth decay and other oral diseases. Basic restorative care covers common procedures including fillings, repair of damaged teeth, crowns and bridges. Finally, major restorative care covers major dental procedures such as replacing teeth and the repair of severely damaged teeth. Generally, most dental plans will provide coverage for preventive and basic restorative services whereas major restorative care and orthodontia benefits are often optional.
Dental plans, like medical plans, can be structured in any number of ways. However, the preferred provider organization (PPO), dental health maintenance organization (DHMO) and the fee-for-service are the most common. PPO plans involve a network of providers in which members are encouraged to use because the fees have been previously negotiated. Members can use an out of network dentist, although the highest level of benefit will be realized staying in the network. DHMO plans are similar to a medical HMO in that members must stay within a limited network of dentists. Finally, a dental indemnity plan allows members to receive service from the provider of their choice and the plan will reimburse them for up to a pre-determined maximum based on the specific service.