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Dental Insurance helps pays for routine dental care as well as injuries caused by accidents.  Most dental insurance is provided through group insurance plans.  Employers often offer this insurance as an employment benefit. 

Policies typically cover oral exams, x-rays, cleaning, fillings, extractions, bridgework, dentures, oral surgery, root canals, and related services.  Coverage is usually subject to a deductible, and the patient is required to make a co-payment of 20% to 50% of the cost.
This coverage is designed to ensure that the insured receives regular examinations and care to prevent dental disease.  Dental plans commonly cover the costs of regular teeth cleaning procedures and dental examinations. 

TYPES OF DENTAL PLANS

Preferred Provider Organization (PPO)
PPOs offer dental care through a panel of dentists who have agreed by contract to treat a group of insureds.  Insureds are encouraged to seek treatment from these participating dentists.  If an insured chooses to obtain treatment from a dentist who does not participate in the panel, the insurance carrier will usually require the insured to pay a greater portion of the cost.

Exclusive Provider Organization (EPO)
This is similar to a PPO but limits the insured’s choice of dentists even further.  Coverage is limited to treatment of the participating dentists.  Therefore, if an insured receives treatment from a dentist who has not contracted to provide services through the panel, the insurance carrier will not pay for the cost of the services.  Insureds may also be restricted from receiving specialized care, and the EPO may limit the number of services that insureds can receive in a calendar year.

In general, plans that allow the patient to choose any dentist will cost more than one in which the patient must select a dentist from a group with rates set by an agreement with the insurer.

Dental plans take several forms.  Each form differs on the basis of treatment, the services they provide, the method of payment for services and the manner in which they control costs.  Most dental insurance plans control costs by limiting the dollar limit on the amount of benefits an insured can receive in one year or limiting the number or type of services that the plan will cover.

Most dental plans cover certain diagnostic services, preventive, and emergency treatment.
Routine services are usually covered without a deductible or co-payment. 

Preventive care reduces the chance that the insured will need more extensive treatment, however additional treatment may be necessary to maintain health. Such routine care or treatment can encompass a wide variety of procedures with plans covering 70% to 80% of the treatment.  The insured pays the balance of the cost.

Major care is usually covered for less than half of the cost under most dental insurance plans.  Benefits can be limited to a certain number of procedures and a dollar amount per year.

Some plans may limit visits to specialists. They may require that the dentist refer the patient to a specialist before covering any treatment by a specialist.  Some plans may require approval from the plan administrator before a specialist can treat the patient.