Types of Dental Insurance

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Capitation dental insurance plans (HMO’s) are when the dentist is paid an annual fee per patient rather than on a treatment basis. However, the dental insurance policy holder may be required to contribute towards the cost of any treatment. The cost of HMO insurance plans are generally targeted at preventative and emergency care and can vary from patient to patient following an initial examination.

Preferred provider organisations (PPO) offer an insurance plan that allows you to visit dentists from a preferred supplier list at a heavily discounted rate. If you choose to use a dentist that is not covered by the dental plan you will still receive some element of discount but nowhere near as much as you will receive from a ‘preferred’ dentist. As with most dental insurance plans an annual cap will apply. Expect to pay up to about $25 per month.

UCR (Usual, Customary & Reasonable) indemnity dental insurance plans have a database which contains average prices for each dental procedure you might undergo. When you submit your bill for payment the dental insurance provider will check the cost of your treatment against the average. If you paid more than the average you will have to incur the additional cost with the insurance company only paying the insured percentage of the fee shown in their database. If the cost of your treatment is lower than average you will receive the agreed percentage of the amount you paid. There is no control over how dental insurance companies calculate the UCR cost and the insurance company always pockets the benefit of lower fees.

Author: Terry Ross

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