Selecting the Right Dental Plan
As a member, you have access to two distinct types of dental plans, a PPO and an HMO. Both types are comprehensive and cover procedures including cleanings, X-Rays, fillings, periodontal issues, crowns, dentures, and implants. The main difference is how the plans work.
PPO Plans are popular as they allow you to use any dentist. Your dentist does not need to belong to a certain network. Specialist referrals are not needed. You are also free to switch dentists at will.
While free to use any dentist, members may choose to use a “Network Dentist”. This is a dentist that has contracted with the insurance company and has agreed to discount their typical rates. Members can typically save 25% to 40% off the regular dental rates.
If you choose to use a non-Network Dentist, the insurance will still cover your treatment, but the dentist will not provide you with any discounts. Therefore, your out-of-pocket costs are likely to be significantly higher than if you used a Network Dentist.
Potential savings you could realize by using an In-Network dentist:
|Procedure||Network Cost||Non-Network Cost||Potential Savings*|
|*Potential savings based on a sample CA zip code using multiple factors. Your specific procedure may fall under a different ADA code.|
HMO Plans use a network of highly qualified dentists that are pre-screened and thoroughly evaluated prior to their acceptance in the network. You must use one of these dentists. You may not use a dentist unless they belong to the network. Specialist referrals are needed and will be provided by your primary dentist.
All services are available from your first day of coverage. Unlike some PPO plans that may have a waiting period for major services like crowns and implants, HMO plans do not have a waiting period for any covered service.
HMO plans have set co-pays for all covered procedures. You will know beforehand what your out-of-pocket cost will be. Unlike PPO plans that have calendar year maximum benefits, HMO plans do not. You never have to worry about running out of available benefits.
When selecting a dental office you have the peace of mind of knowing that you are never locked into that dental office. You may switch dental offices as often as you like, just by calling the insurance company and letting them know you wish to change.
Plan Exclusions & Limitations are conditions all insurance plans have. Limitations and Exclusions may affect how often a procedure may be done and what is covered. These can vary between companies and plan types. For example, both plans allow for three cleanings per year. However, the Ameritas PPO plan allows for a crown replacement once every ten years, while the Cigna HMO plan allows for replacement once every five years. These issues should be taken into consideration when choosing a plan.
One clause that is a standard in almost all dental insurance policies is the Missing Tooth Clause. Insurance covers potential future events, not events that have already happened in the past. Therefore, if you have a missing tooth before the date this insurance started, the insurance will not cover an implant or bridge to replace that missing tooth.