Dental Insurance Plans

Individual dental insurance plan

Individual dental insurance plans come in different forms to cater to the wide variety of needs of the different consumers. There are some essential differences in the different individual dental insurance plan and as a subscriber to these policies you should be aware of these differences.

For an individual dental insurance plan there are three parties involved. The patient, the dentist and the third party(the dental insurance provider). Usually the dental insurance is provided by the employer and so they contract with some dental insurance company to provide you with the family or individual dental insurance plan. There are different types of third parties - dental service corporation like Delta Dental, Blue Cross, For profit organisations which under write your financial risk, self-funded insurers where the employer itself sets aside some amount for providing dental care costs for its employees.

Next essential difference between the various individual dental insurance plans is regarding choosing a dentist. If under your plan you are allowed to pick any dentist of your choice it is called an open panel or freedom of choice plans and generally more expensive. The closed panel individual dental insurance plan allows you to choose from a selected panel of dentists contracted with the third party or dental plan provider.

Again closed panel individual dental insurance plans are of two types. You might have heard of PPO plans and EPO plans. Preferred Provider Organisation (PPO) - you can choose to receive dental care from preferred panel of dentists. These contracted dentists charge less than usual fee to the plan buyers. If you choose to receive treatment from some dentist outside this panel you are required to pay a greater share of the fee-for-service.

In an Exlusive Provider Organization (EPO) you can opt for treatment only from particular group of dentists who are participating with the dental plan. You will not covered under the plan unless you take treatment from these participating dentists. Though exceptions may be allowed for extreme emergencies. The dentists might be salaried employees of the plan provider. Also under this plan there may be several restrictions both for number of services you recieve and the type of service you receive. These are cheapest individual dental insurance plans.

Third essential difference between the different individual dental insurance plans is based on who pays the dentist. Under the Indemnity plans the insurance company directly pays the dentist part of fee (5-80 percent)for services rendered to the patient. Remaining amount paid by patient. A monthly premium is paid by patient/ employer to the insurance company. Services may be limited and there might also be an yearly cap on spending.

Capitation individual dental insurance plans provide comprehensive dental cover through some chosen dentists. An example of this type of individual dental insurance plan is the Dental Health Maintenance Organisation or DHMO. Dentists are paid on per head rather on basis of services provided. Some part of the fee has to be borne by patient in addition to the monthly premium paid to the dental insurance provider.

The direct reimbursement plan is one operated by the employer. After receiving dental treatment from a dentist the receipt is presented who reimburses a fixed percentage of the costs borne by the patient. This is paid from the employer's own funds and no other third party is involved in this type of individual dental insurance plan.

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