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Results from search: http://www.metlife.com/dental/

Results from search: http://www.howstuffworks.com/dental20.htm

Howstuffworks "Digesting the alphabet soup of dental insurance"     Free Newsletter! .  Suggestions! .  Win! .  About HSW .  Contact Us .  Home   Daily Stuff .  Top 40 .  What's New .  HSW Store .  Forums .  Advertise!         Supercategories!   Automotive   Body & Health   Computers   Cool Stuff   Electronics   Engines   Home   Internet   Entertainment   Money   Science & Tech   Society & Culture   Toys & Games   Transportation   Weapons Get Stuff!  -  Order "HowStuffWorks"  -  Order "How Much     Does the Earth Weigh" Click here to view your points! Digesting the alphabet soup of dental insurance by Dr. Jerry Gordon >>Tell a friend about this article!    How Stuff Works is pleased to welcome Dr. Jerry Gordon as the HSW dental expert! Learn more about Dr. Gordon Check dental references Legal Understanding the alphabet soup of dental insurance plans can be a difficult endeavor for most people. Two common insurance acronyms include PPO and HMO. Managed care plans are often either PPO or HMO, standing for preferred provider organization and health maintenance organization. With PPO insurance plans, the companies negotiate fee schedules with dentists in exchange for the dentist being put on a list of "preferred" providers. Employers give the list to their employees to match them up with dentists who participate with the dental plan. Dental insurance can help people pay for dental treatment, but it has its limitations. Most insurance plans have a deductible of $50 to $100, pay only a specified percentage for each type of treatment, and have a yearly maximum amount of funds available for dental care. Most PPO plans cover preventive care, cleanings, check-ups, protective dental sealants, x-rays, and fluoride treatment at 80-100%. Basic care, including root canal therapy, extractions, and fillings are usually covered at 80%. Major care such as crowns (caps), permanent bridgework, and full and partial dentures as well as periodontal (gum) care are often covered at 50%. Many insurance companies have a yearly maximum of a $1000. Dental insurance is not cumulative, so if you don't use it, you lose it. It is interesting, and disappointing, to note that when dental insurance companies became common in the early 1970's, the yearly maximum in many was the same $1000 it is today, even though the cost of delivering dental care has nearly tripled since then. HMO's have received a barrage of negative publicity in recent years, primarily in the medical community, for dubious "gag" clauses in the contracts, bureaucratic snafus, and the limitation of appropriate care of patients by their physician. While some HMO insurance plans may be adequate for practitioners in the medical community, they are more difficult to justify in the dental community. The main reason is that practice overhead is generally higher in the average dental practice than the average medical practice, and the financial compensation from most HMO's is very low. 65 to 70 cents of every dollar received at the average dental office is consumed by office overhead, including staff salaries, supplies, laboratory fees, rent, etc. The reduced fees allowed by dental HMO's has participating dentists doing many dental treatments at a financial loss. A recent study by the American Dental Association found that the average dental HMO does not even adequately reimburse inexpensive preventive dental care. Consequently, a dental practice with a majority of patients having HMO insurance is often forced to see patients quickly- too quickly in my opinion, to develop the necessary rapport essential to the dentist- patient relationship. A dentist I know told me that when an HMO patient comes into his office for a cleaning, he does not give that patient the "free" toothbrush that he routinely gives to his other patients. As you might have guessed, I am not a big fan of HMO's. We do not participate with any HMO's but are involved with some PPO's. Dental insurance can help people pay for routine dental visits, but it has many limitations. Always discuss your insurance plan and financial obligations with either your dentist or the office manager prior to dental treatment. Links The American Dental Association American Academy of Pediatric Dentistry Dental America - Discount dental insurance   Join HSW!   ||   Newsletter   ||   Suggestions   ||   Link to HSW   ||   Hiring Win!   ||   Store   ||   About Us   ||   Contact Us   ||   Privacy   ||   Home Frequently Asked Questions   ||   Advertising Copyright © 1998-2002 Howstuffworks, Inc. All rights reserved Sponsored By: Daily Stuff Question of the Day Gadget of the Day Survey of the Day Article of the Day Top 40 of the day! Related Books . HowStuffWorks: The Reference Book . How Much Does the Earth Weigh . For more books, click here!

Results from search: http://www.insurancecompany.com/dental.html

Dental Insurance for Individuals, Family and Groups   . Low Monthly Premiums  . Reliable Dental Offices  . No Maximum Benefits  . No Claim Forms  . No Deductibles  . Good Co-Payments  . Hassle Free Enrollment  . Orthodontics Included  . No Limit On Visits  . Largest Provider Base Group Plans  |  FAQ  |  Contact Us  |  Privacy  DENTAL INSURANCE,  DENTAL PLAN , VISION AND PRESCRIPTION COVERAGE PLANS Insurance Company . com is a specialist in discount dental care, dental insurance, dental plans, vision and prescription coverage programs for individuals and families. We have been in business since 1983 and offer several dental insurance plans, dental discount plans, vision and prescription programs depending upon the state you live in... Dental Plan - Enter Your State Dental * Vision * Prescription Benefit Pre-existing conditions are covered except orthodontic treatment in progress. Braces, implants, teeth cleaning and more without a waiting period. There are no deductibles, no claim forms to fill out and no limit on visits to the dentist in most states. Please Select Your State... Select Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Members can save on all dental charges and procedures including dental restorative cosmetic work (fillings, dental crowns, dental braces, dental implant's) and dental product related items, etc.), dental hygiene services, preventative work (teeth cleaning, x-rays, etc).  General dentistry, dental hygienist, dental assistant, dental assisting and all specialties where available are covered. DENTAL , VISION AND PRESCRIPTION COVERAGE Thank you for choosing Insurance Company . com   we look forward to serving you and your family... email Insurance Company . com Copyright 1997-2002. Del Amo. All rights reserved.  

Results from search: http://www.insurance-dental.com/

Our Dental Insurance Plan / Optical Plan all for less than $4.00/week for Family! 30 day Money Back Guarantee ! Call Toll Free-USE COUPON Z100. Dental Insurance, Dental Plan, Dental Care,Vision Care, Prescription Card, brases, orth   We provide access to America's largest dental network and are offering a dental plan\vision plan for less than $4.00 per week.Our Dental plan offers a no risk 30 day money back guarantee!  E N T E R       Home | Info | Coupon | Secure Signup | Contact   Copyright 2000 Dental-America   dental insurance, dental plan, health insurance, hospitalization, vision care, prescription card, prescription plan, generic, dental insurance, dental care, dentists,business opportunity, network marketing, health care, HMO, PPO, hmo, ppo, health care provider, provider list, employee benefits, dental plan, dental plan, dental insurance, braces, orthodontics, employee benefits, dental plan, dental insurance, health insurance, health insurance, dental insurance, eye care, vision care, glassess, dentist, employee benefits, health benefits, dental insurance, hospitalization, vision care, prescription card, prescription plan, generic, dental insurance, dental care, dentists, business opportunity, network marketing, health care, HMO, PPO, hmo, ppo, health care provider, provider list,employee benefits, dental plan, dental plan, dental insurance, braces, orthodontics, employee benefits, dental plan, dental insurance, health insurance, health insurance, dental insurance, eye care, vision care, glassess, dentist, employee benefits, health benefits, dental insurance, hospitalization, vision care, prescription card, prescription plan, generic, dental insurance, dental care, dentists, business opportunity, network marketing, health care, HMO, PPO, hmo, ppo, health care provider, providerlist .

Results from search: http://www.cigna.com/consumer/

CIGNA.com - Providing health, retirement, accident, disability, and other employee benefits Convenience Center Provider Directory Shop@drugstore.comT Healthy Rewards® Drug List Prescription Center Mail Order Drugs CIGNA's AnswerNet ® CIGNA Trade ® Brokerage Services Academy by CIGNA ® Expatriate Benefits Health Information Your Health Health Behavioral Health Dental Pharmacy Your Money Access Your Accounts Workplace Investment Options Brokerage Products & Services Brokerage Investment Options Leaving Your Job Market News Your Security Life Insurance Accident Insurance Disability Insurance Your Health Your Health@CIGNA ® Glossary of Health Terms Health Care Fraud Your Money Academy by CIGNA ® Straight Talk Investment Basics Glossary of Financial Terms Your Health Provider Directory Your Money Retirement Fact Quiz 401K Calculator Retirement Income Calculator Tax Deferred Calculator Present/Future Value Calculator College Funding Calculator Savings Goal Calculator Lump Sum Distribution Calculator Retirement Planning Calculator Commission Calculator Your Health Medical Claim Form Dental Claim Form Expatriate Claim Forms Pharmacy Forms Reimbursement Request Update Your Plan Coverage Your Money Open an IRA Account Open a Brokerage Account Automatic Savings Program Your Security Submit a Disability Claim Disability Disclosure Authorization For CIGNA HealthCare Members For Expatriates For Local Country Nationals Useful International Links Your Health Health Behavioral Health Dental Pharmacy Your Money Retirement & Investment Services CIGNA Financial Services Distribution Assistance Your Security Life, Accident & Disability Preview myCIGNA.com - your personal health care and retirement plan Web pages. Please Your Employees (and your boss) at the Same Time. CIGNA Named One of Top 50 Best Companies for Latinas to Work CIGNA Conducts Coast-to-Coast Search for Nurses. Tips for the Mother-to-Be CIGNA Named Among Top Companies for Executive Women CIGNA HealthCare Forms New Vision Care Specialty Company: CIGNA Vision Care, Inc. Support Services for Disaster Victims and Their Families  Change Your Physician Provider Directory Check Your Retirement Account CIGNA Tel-Drug Mail Order Prescription Center Access Your Brokerage Account Submit a Disability Claim Healthy Rewards-Discounted Products/Services Let CIGNA Compass ® Manage Your Portfolio Use Network Dentists and Save Access Your Behavioral Health Benefits Online © 2002 CIGNA Legal Disclaimers | Link to Our Site | Privacy Statement (Updated 10/05/2001)

Results from search: http://www.hanninsurance.com/health.html

Health Insurance,blue cross,dental insurance,health,ppo blue cross,blue cross,health insurance,dental insurance,health insurance,health insurance,blue cross,blue cross,health,ppo,dental insurance,dental insurance Health Insurance Quote Information Sheet CALIFORNIA ONLY Please Click on Insurance Categories below for a Free Quote PLEASE FILL OUT THE INFORMATION BELOW AND HANN INSURANCE AGENCY WILL SEND YOU A HEALTH BROCHURE WITH RATES Information Needed For Reply Email:   Name: Address: City: State: Zip: Phone: - Fax: -   * Not Required How did you find our web site ? Please Select Alta Vista Another Insurance Company Aol Search Ask Jeeves Excite GoTo Net Google Hotbot Infoseek Lycos MaMa MetaCrawler Netscape Search NorthernLight Referred by someone Starting Point Webcrawler Yahoo Yellow Pages Other (Please specify below...)   * Not Required Any Further Questions: If something is not listed here, or you have any questions about your coverages, or need to know how to answer a question, E-mail us at mail@hanninsurance.com Or call our direct telephone line at (760) 365-9744. IMMEDIATE RESPONSES ON ALL QUOTES. WE CAN SAVE YOU MONEY Disclaimer: All quotes are subject to change. Quotes are based on the information you provide. Please be as accurate as possible so we can be as accurate as we can. Please Click on Insurance Categories below for a Free Quote All Contents ©Copyright

Results from search: http://www.uneb.edu/Employees/2002/dentalbluecross2002.html

Dental Insurance Dental Insurance     General Eligibility Effective Date of Coverage "Change in Status" Guidelines COBRA Termination of Coverage Student Eligibility Leave of Absence   Blue Cross Blue Shield Company Overview Group Identification Number Benefits Summary Provider Network (Select the BluePreferred (PPO) Network from the drop-down menu.) Premium/Price Tag Information Blue Cross Blue Shield Contacts Frequently Asked Questions   Return to Employee Benefits Home Page Eligibility Employee Employees are eligible for group dental insurance coverage if they are employed in a "regular position" with an FTE of .5 or greater or employed in a "temporary position" for more than 6 months with an FTE of .5 or greater. Dependents Spouse: §          Husband or wife, as recognized under the laws of the state of Nebraska . §          Common-law spouse if the common-law marriage was contracted in a jurisdiction recognizing a common-law marriage. Child: §          Natural-born or legally adopted child who has not reached the limiting age of 19. §          Stepchild who is living in the employee's home and is chiefly dependent on the employee for support, and who has not reached the limiting age of 19. §          Child for whom the employee has "legal guardianship" and who has not reached the limiting age of 19. Appropriate documentation must be provided to verify the court appointed "legal guardian" status. §          Mentally or physically handicapped child who has not reached the limiting age of 19. Coverage is also available beyond age 19 if proof of disability is provided. §          Child of a deceased employee who has not reached the limiting age of 19. Student (ages 19-24): §          Dependent child who has not reached the limiting age of 24 and is a full-time student. §          Full-time student status generally requires a dependent to enroll for 12 or more undergraduate (9 or more graduate) credit hours each semester. The number of credit hours required for full-time student status is however, based on each school's definition of a full-time student. Effective Date of Coverage Coverage is effective on the first day of the month following the employee's date of hire or eligibility. Coverage for employees hired on the first day of the month or first working day of the month is effective immediately. The dental insurance option elected will be in effect for up to two (2) years until the annual NUFlex enrollment that allows dental election changes. Coverage changes may be made however, during the year as noted in the "Change in Status" section. "Change in Status" Guidelines Employees may change their dental insurance coverage category during the calendar year when 1) a qualified "change in status" event occurs and 2) the employee's requested change is consistent (on account of and corresponds to) with the event. Employees must make changes in coverage within 31 days of the qualified "change in status" event. Listed below are several common qualified "change in status" events that allow an employee to initiate a mid-year dental insurance coverage change. §          Change in Employee's Legal Marital Status §          Change in Number of Dependents §          Change in Employment Status or Work Schedule Which Results in a Gain or Loss of Coverage Eligibility §          Dependent Satisfies or Ceases to Satisfy Dependent Eligibility Status §          Change in Residence or Worksite of Employee, Spouse or Dependent that Affects Eligibility for Coverage COBRA Eligibility Employee and/or their dependents may continue group dental insurance coverage through COBRA for up to a predetermined period of time as a result of termination, ineligible dependent, divorce, or loss of coverage for any reason (excluding gross misconduct). 18 Months Coverage may be continued for up to 18 months* when the employee's dental insurance ends due to 1) voluntary or involuntary termination of employment (except for gross misconduct) or 2) reduction in work hours. As long as the applicable premium is paid, coverage may be continued until the earliest of the following dates: §          The date the insured becomes covered under another group dental plan that does not exclude or limit any preexisting condition. COBRA allows an insured to continue the University's group coverage for a preexisting condition that is not covered under another dental plan, subject to the provisions of the Health Insurance Portability and Accountability Act (HIPAA). §          The date for which timely premium payment is not made. §          The date the University ceases to provide dental insurance coverage to its employees. *A qualified individual is eligible for an additional 11 months of COBRA coverage if the qualified beneficiary is determined to be disabled (under Title II or XVI of the Social Security Act) at any time during the first 60 days of continued coverage. The qualified beneficiary must notify the Campus Benefits Office within 60 days of the determination and before the end of the 18-month continuation. A timely election under this law requires the employee to sign and return the COBRA Election Form within 60 days. The election period begins 60 days after the later of: a) the date the employee loses coverage, or b) the date the employee was sent the Notice. Qualified beneficiaries include the employee's spouse and/or dependent children, including children born or adopted during a period of COBRA. 36 Months Coverage may be continued for up to 36 months when the employee's dental insurance ends due to 1) death of the employee, 2) divorce or legal separation, or 3) dependent child ceases to qualify as a dependent under the dental plan due to the limiting age. As long as the applicable premium is paid, coverage may be continued until the earliest of the following dates: §          The date the insured becomes covered under another group dental plan that does not exclude or limit any preexisting condition. COBRA allows an insured to continue the University's group coverage for a preexisting condition that is not covered under another dental plan, subject to the provisions of the Health Insurance Portability and Accountability Act (HIPAA). §          The date for which timely premium payment is not made. §          The date the University ceases to provide dental insurance coverage to its employees. A timely election under this law requires the employee to sign and return the COBRA Election Form within 60 days. The election period begins 60 days after the later of: a) the date the employee loses coverage, or b) the date the employee was sent the Notice. Qualified beneficiaries include the employee's spouse and/or dependent children, including children born or adopted during a period of COBRA. Termination of Coverage Coverage terminates on the last day of the month following the date of termination or date the employee is no longer eligible. Student Eligibility Blue Cross Blue Shield of Nebraska will forward a "student eligibility questionnaire" to each employee upon a dependent child's attainment of age 19 to verify the dependent's student status. Thereafter, "student eligibility questionnaires" will be forwarded in June (for the September through December semester) and October (for the January through August semester). Leave of Absence Employees may continue dental insurance coverage while on an approved leave of absence for up to 2 years. The employee should contact the Campus Benefits Office to establish the direct bill premium payment process. Company Overview   For more than 60 years, Blue Cross and Blue Shield of Nebraska has helped Nebraskans with their health care coverage needs by offering a wide variety of insurance products and services. In 1939, the beginning of a long tradition of health care coverage was created in Nebraska when a group of medical professionals, business leaders and others gathered together to form an organization that today cares for more than 620,000 Nebraskans. Blue Cross and Blue Shield of Nebraska is an independent licensee of the Blue Cross and Blue Shield Association and insures nearly one in three Nebraskans. Blue Cross and Blue Shield of Nebraska offers a variety of coverage plans for groups and individuals, including: traditional health care coverage; PPO coverage, HMO coverage and POS (Point of Service) coverage, and a variety of Medicare Supplement plans. In 2001, Blue Cross and Blue Shield of Nebraska received the Heartland Better Business Bureau's Business Integrity Award for Service Excellence. The award recognizes businesses which have consistently set exceptionally high standards of behavior in the marketplace. The Integrity awards are presented annually to companies which honor their promises, treat customers and employees with respect, and provide the highest quality service with excellence and consistency. Blue Cross and Blue Shield of Nebraska won the top award for companies with more than 200 employees. In 2000, Blue Cross Blue Shield of Nebraska was awarded its fifth national Blue Cross and Blue Shield Association's Brand Excellence Award. The Brand Excellence Award is based on the results of surveys that gauge the impressions and loyalty of both consumers and health care purchasers for Blue Cross and Blue Shield of Nebraska in comparison to competitors. Enrollment growth, customer service and satisfaction, and financial strength were also measured.   Visit Blue Cross and Blue Shield of Nebraska's Home Page. Group Identification Number §          13200 Benefits Summary - 2002 The dental plan has been designed to pay a significant portion of the cost for checkups and to provide cost-sharing benefits for needed restorative work up to the annual maximum benefit. Preferred Provider - Dental A component of the Blue Cross Blue Shield dental plan is a preferred provider dental program (BluePreferred). By choosing a provider who is a member of the BluePreferred network, you save money through: §          Discounted fees by the provider §          No claim forms §          Reduced deductibles §          Lower coinsurance payments §          No balance billing by the provider   Type of Service Annual Deductible Coinsurance Plan Pays/You Pay Benefit Maximums   PPO provider Non-PPO provider PPO provider Non-PPO provider PPO provider Non-PPO provider Preventive and Diagnostic None None 85%/15% 80%/20% $1,500/person annual maximum for all preventive, restorative, and major dental services combined. $1,500/person annual maximum for all preventive, restorative, and major dental services combined. Restorative Dental Services & Major Dental Services $25/person $35/person 85%/15%     50%/50% 80%/20%     50%/50% Orthodontic $40/person $50/person 50%/50% 50%/50% $2,000/person lifetime maximum $2,000/person lifetime maximum Blue Cross Blue Shield of Nebraska Contacts §          Customer Service (888) 368-2227 §          Preferred Provider Information (888) 368-2227   Return to Employee Benefits Home Page Copyright © 2002 University of Nebraska Board of Regents. For concerns and questions regarding this web page, please contact: Michael A Fields  

Results from search: http://www.standard.com/benefits/dental_insurance.html

The Standard | Benefits for Business | Dental Insurance       Dental Insurance from The Standard Dental Insurance from The Standard   |   Group Dental Plans Participating Provider Organizations      Offering two decades of dental experience, Standard Insurance Company is well equipped to meet employers' dental insurance needs. For employer-paid and employee-paid group dental insurance policies, we provide a complete line of flexible plans, allowing us to tailor coverage that balances affordability for employers and quality care for employees.      Our dental products provide a choice of plan designs and provisions that help employers find the right coverage for their employees. With variable designs ranging from traditional indemnity to voluntary, we work with employers to create dental plans that suit their requirements. Learn more about our Group Dental Plans and then contact your local Employee Benefits Sales and Service Office for help in creating the right dental plan to meet your needs. Products and provisions described may not be available in all states. Specific provisions may vary by state. The products and coverages have exclusions, limitations, reductions of benefits and terms under which they may be continued in force or terminated. Please contact The Standard for additional information, including costs and complete details of coverage. SI 9000 Ed. 01-02 w/insert pages     © Copyright 2002 StanCorp Financial Group, Inc. All rights reserved. Privacy Policy and Legal Notices .

Results from search: http://www.ada.org/public/faq/insurance.html

The Public: Frequently Asked Questions: Dental Benefits/Insurance The Public Oral Health Topics   A-Z Listing    Category Listing Benefits/Insurance   Return to Oral Health Topic: Benefits/Insurance Consumer questions: publicinfo@ada.org Frequently Asked Questions Benefits/Insurance What is dental insurance for individuals? What are some questions and concerns about dental benefits? How do I understand dental benefit plans? How are benefits determined? See also:  Direct Reimbursement Dental Insurance for Individuals Dental plan coverage for individuals is not commonly offered because dental needs are highly predictable. For example, you would not pay premiums for your dental coverage if the premiums were more expensive than the cost of the dental treatment you need. Since this is the case, insurance companies would stand to lose money (spend more on benefits than they receive in premiums) on every individual dental plan they write. There are, however, a few companies that offer a form of dental benefits for individuals. Most of these plans are "referral plans" or "buyers' clubs." Under these types of plans, an individual pays a monthly fee to a third party in return for access to a list of dentists who have agreed to a reduced fee schedule. Payment for treatment is made from the patient directly to the dentist. The third party acts only in the capacity of matching the individual to the dentist. The dentist receives no payment from the third party other than in the form of referral of patients. Back to Top Questions or Concerns About Dental Benefits Your plan sponsor (often your employer) should be able to explain the individual design features of your plan. Design features to understand include: exclusions, limitations, patient copayments and annual or lifetime benefit maximums. The American Dental Association has received numerous questions and complaints from patients regarding their dental benefits. To correct some of this confusion about dental coverage, the following questions and answers are provided by the American Dental Association to help you better understand your dental benefits. If you have additional concerns or questions, they should be directed to your group benefits department. Your personal dentist may also be able to explain dental benefit issues and options for you. My dentist recommends a treatment that my plan will not pay for. Does this mean the treatment really isn't necessary? It is common for dental plans to exclude treatment that is covered under the company's medical plan. Some plans, however, go on to exclude or discourage necessary dental treatment such as sealants, pre-existing conditions, adult orthodontics, specialist referrals and other dental needs. Some also exclude treatment by family members. Patients need to be aware of the exclusions and limitations in their dental plan but should not let those factors determine their treatment decisions. My dentist recommends that I get a crown on a tooth, but my dental benefit will only pay for a large filling for that tooth. Which treatment should I have? Some plans will only provide the level of benefit allowed for the least expensive way to treat a dental need, regardless of the decision made by you and your dentist as to the best treatment. Sometimes, special circumstances may be explained to the third-party payer to request an adjustment to this lower benefit allowance, but there is no guarantee that the third-party payer will alter its coverage. As in the case of exclusions, patients should base treatment decisions on their dental needs, not on their dental benefit plan. My dental plan says that it will pay 100 percent for two dental checkups and cleanings each year. However, I just had my first checkup and cleaning, and now the insurance company says I owe for part of the dentist's charge. How can this be? Plans that describe benefits in terms of percentages, for example, 100 percent for preventive care or 80 percent for restorative care, are generally Usual, Customary and Reasonable (UCR) plans. The administrators of UCR plans set what the plan considers to be a "customary fee" for each dental procedure. If your dentist's fee exceeds this customary fee, your benefit will be based on a percentage of the customary fee instead of your dentist's fee. Exceeding the plan's customary fee, however, does not mean your dentist has overcharged for the procedure. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called "customary," they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the "customary" fee level. Will my plan cover the care my family will need? This should be a prime consideration and a major motivation in choosing one plan over another. If your employer offers more than one plan, look at the exclusions and limitations of the coverage as well as the general categories of benefits. You should discuss your family's current and future dental needs with your family dentist before making a final decision on your dental plan. Who is covered by my dental benefit plan? What does my dental plan cover? This information should be provided by the plan purchaser, often your employer or union, and by the third-party payers. In order that you and the dentist may be aware of the benefits provided by a dental benefit plan, the extent of any benefits available under the plan should be clearly defined, limitations or exclusions described, and the application of deductibles, copayments, and coinsurance factors explained to you. This should be communicated in advance of treatment. The plan document should describe the benefit levels of the plan and list any exclusions or limitations to that coverage. This document should also specify who is eligible for coverage under the plan and when that coverage is in effect. Your dentist cannot answer specific questions about your dental benefit or predict what your level of coverage for a particular procedure will be. This is because plans written by the same third-party payer or offered by the same employer may vary according to the contracts involved. Therefore, you should ask the plan purchaser or the third-party payer to answer your specific questions about coverage. My dentist is not on the list of dentists provided by my employer. Can I still go to him or her for treatment? You can always go to the dentist of your choice. The question is whether you will have benefit coverage for the treatment you receive if it is provided by a dentist who is not on the plan's list. This depends on contractual agreements between the plan purchaser (often your employer), the dentists on the list and the plan administrator. Under certain contracts, such as a PPO (Preferred Provider Organization) program, patients are given a financial incentive to go to certain dentists but do receive some level of dental benefit, regardless of the treating dentist. Other plans, such as capitation programs, do not provide any benefit coverage for treatment given by "non-participating" dentists. In all instances where this type of plan is offered, patients should have the annual option to choose a plan that affords unrestricted choice of a dentist, with comparable benefits and equal premium dollars. My spouse and I each have a dental benefit plan. Whose program covers whom? Can we decide whose program covers our children? Your program covers you. Your spouse's program covers him or her. You may have additional coverage from each other's programs if they cover spouses and dependents. In no case should the benefit derived from the two coordinated programs exceed 100 percent of the dentist's charges for treatment. The primary plan for covering your children depends on the regulations in your state. Most plans use the "birthday rule" (spouse with birthday occurring earlier in the calendar year is primary). Others consider the father's plan primary. The American Dental Association has recognized the "birthday rule" as the preferred method for coordinating benefits, but which rule applies to your family depends on the language in your dental plan documents. If you have two or more potential sources of coverage, check the coordination of benefits language for each plan to determine the benefits available. Does my dentist have to send a description of my treatment plan to the third-party payer before I have any dental work done? Third-party payers often request a "predetermination of benefits" on certain treatment plans. Usually this means a dental consultant will review your dentist's treatment plan and determine what benefits your plan will provide. But this predetermination is not a guarantee of payment. You may want to review your benefit prior to receiving treatment, but the final treatment decision should be a matter between you and your dentist, regardless of your benefit. There may be a provision in your plan that will deny your normal dental benefit, or reduce the level of coverage if you do not submit the treatment plan for prior authorization. This is a contractual matter between the plan purchaser (often your employer) and the plan administrator and is contrary to the policy of the American Dental Association. The American Dental Association is opposed to any dental clause that would deny or reduce payment to the beneficiary, to which he/she is normally entitled, solely on the basis or lack of preauthorization. Back to Top Understanding Dental Benefit Plans Employers and other plan sponsors offer dental benefits for a variety of reasons, including promotion of oral health and attraction and retention of high-quality employees. Regardless of why the plan is offered, its intent is the same: to help individuals by paying for a portion of the cost of their dental care. Almost all dental benefit plans are the result of a contract between the plan sponsor (usually an employer or a union) and the third party (usually an insurance company). For this reason, concerns about your dental plan should first be directed to your plan sponsor. Limitations in coverage are the result of the financial commitment the plan sponsor has agreed to make and the benefits the third-party payer will offer in exchange for that commitment. Treatment decisions must be made by you and your dentist. While dental benefit coverage should be taken into account, it should not be the deciding factor in your choice of treatment. Back to Top How Benefits Are Determined You should know how your plan is designed, since this can affect significantly the plan's coverage and your out-of-pocket expense. Some employers now offer more than one dental plan to their employees. In fact, the right to choose between two plans could be the law in your state. To understand and make decisions about your dental benefits, it is important to remember that plans are often very different. To make the best decision for you and your family, you should understand exactly how the different kinds of dental benefit plans work and how they derive their cost savings. There are many ways to design a dental benefits plan. Although the individual features of plans may differ somewhat, the most common designs can be grouped into the following categories: Direct Reimbursement programs reimburse patients a percentage of the dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patients to go to the dentist of their choice. "Usual, Customary and Reasonable" (UCR) programs usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called "customary," they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the "customary" fee level. Table or Schedule of Allowance programs determine a list of covered services with an assigned dollar amount. That dollar amount represents just how much the plan will pay for those services that are covered. Most often, it does not represent the dentist's full charge for those services. The patient pays the difference. Preferred Provider Organization (PPO) programs are plans under which contracting dentists agree to discount their fees as a financial incentive for patients to select their practices. If the patient's dentist of choice does not participate in the plan, the patient will have a reduction or complete loss of benefits. Capitation programs pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge (for some treatments there may be a patient copayment). The capitation premium that is paid may differ greatly from the amount the plan provides for the patient's actual dental care. Back to Top I would like to ask my employer to provide a dental benefit plan through the company. How should I go about doing this? The American Dental Association recognizes the important role dental benefits have played in improving access to dental care for millions of Americans. You or your employer may contact the Association for more detailed information about how employers of all sizes can provide a cost-effective, high-quality dental benefit plan for their employees.  Back to Top What is direct reimbursement? Direct Reimbursement programs reimburse patients a percentage of the dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patients to go to the dentist of their choice. Click here for more information on Direct Reimbursement. Back to Top Page Posted: March 4, 1999 Page Update: April 03, 2002

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Home, Auto, Health & Life Insurance FREE QUOTES - Auto Insurance - Life Insurance - Renter's Insurance Condominium Insurance - Homeowners Insurance - Flood Insurance - Individual Health Insurance - Individual Dental Insurance - Chubb Masterpiece PRODUCTS/INFORMATION - More Information - The Advantage For Renters - The Advantage For Condominium Owners - Valuable Articles Insurance - Personal Excess Coverage - Personal Insurance Solutions for the 21st Century - Client Newsletter Don't wait until a loss occurs to find out if you have adequate protection. If you are interested in what we can offer you, please complete any of our request forms, or send an e-mail to us or call us at 1-800-526-1379. Broaden Your Horizons Add dental benefits to your Horizon Blue Cross Blue Shield of New Jersey medical plan. Exceptional Savings The Horizon Dental Companion and Horizon Basic Dental Companion plans cover eligible diagnostic services including exams and preventive treatment such as cleanings at no out-of-pocket cost to your employees when they use a dentist in the Horizon Dental PPO network of more than 2,700 dentists.  The Horizon Dental Companion Plan also provides 100 percent coverage for selected eligible services such as amalgam fillings, full mouth X-rays and space maintainers. In addition, customers receive the benefits of the negotiated, reduced fees for eligible major and specialty services such as crowns, bridges, dentures and periodontics with no deductibles and no benefit maximums draining your employees' wallets. Members have the advantage of access to reduced fees for eligible services not covered in their plan.  For services not covered in their plan, members pay the participating dentist the Horizon Dental PPO Plan fee for these services.  There is no balance billing. Compare the Savings The average family of four can save on out-of-pocket costs for eligible major dental services when using a dentist in the Horizon Dental PPO network.   For example, the typical cost of a full mouth X-ray is $63. The out-of-pocket expense would be: $0 with the Horizon Dental Companion Plan

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