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Dental Plans-Things You Should KnowGroup, Family or Individual Dental Plans Contain Terms-Pre-Existing Conditions, Waiting Periods and Other Complex Dental Terms. |
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Common Terms Associated With Dental Insurance
Usual, Customary and Reasonable There is no regulation as to how insurance companies determine reimbursement levels in a dental insurance policy. This can result in very wide fluctuations. "Usual, customary and reasonable" (UCR) may be one of the most misunderstood terms used in describing dental insurance. UCR plans may pay an established percentage of the dentist's fee, or what the plan considers a "customary" or "reasonable" fee limit, whichever is less. Although these limits are called "customary", they may or may not reflect the actual fees that dentists in your area charge. Since our dental plans are not insurance, discount dental plan members pay a membership fee which allows them to pay discounted rates at participating dental providers, at the time services are rendered. Most dental insurance plans place an annual cap on the amount of reimbursement, usually $1,000 to $1,500 per year. The insured is responsible for all costs incurred after that, in the same year. Since our dental plans are not insurance, discount dental plans have no annual maximum. Least Expensive Alternative Treatment Provision Some dental insurance plans will only pay for the least expensive treatment in a particular situation. For example, your dentist may recommend a crown on your tooth, but the insurance policy will only provide reimbursement for a filling. Since our dental plans are not insurance, discount dental plans contain no "Least Expensive Treatment" provision. Just as with health insurance, the dental plan may not cover conditions an individual had before enrolling in the group plan or the individual dental insurance policy. Other plans will place long waiting periods, anywhere from 6 to 18 months, before paying for major dental treatment. Since, discount dental plans are not insurance, ongoing dental problems are covered immediately, with only minor exceptions. This is an amount that you will pay first, before the insurance company will start any reimbursement. The deductible may range from $50-$100, or more. This deductible normally must be satisfied before any treatment, even preventative treatment, will be reimbursed. Since, discount dental plans are not insurance, dental plans provide instant savings with no waiting periods and no deductibles. |
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AFFORDABLE DISCOUNT DENTAL PLANS AND DISCOUNT HEALTH PLANS FOR INDIVIDUAL & FAMILY ARE NOT DENTAL INSURANCE OR HEALTH INSURANCE Discount Health Plans and Discount Dental Plans offered are not health or dental insurance. Plans offered provide discounts at certain dental and medical providers for healthcare services. Plans offered do not make payments directly to the providers of healthcare. The plan member is obligated to pay for all healthcare services but will receive a discount from those dental or medical healthcare providers who have contracted with the Discount Medical Plan Organization. |
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