This plan gives the member freedom to choose any dentist you want. Once
you visit the dentist, you pay for the services and submit and claim to the dental plan
administrator for reimbursement. There is usually a deductible you must meet prior to
receiving payment for service. The plan normally reimburse you for a certain percentage of
the bill 80 percent or 50 percent. There are no reasonable and customary limits.
Dental Maintenance Organization (DMO)
This plan is similar to an HMO (Health Maintenance Organization). The plan offers a
network of dentists from which to choose. You may go to any of these dentists for care and
show your member ID card. The dentist files the claim on your behalf. You are not subject
to any reasonable and customary limits. The plan usually pays 100 percent for preventive
care and 80 percent for other dental services. You must use the network dentists in order
for benefits to be paid. Premiums will be highest with this plan because the coverage is
the most comprehensive.
Dental Preferred Provider Organization
This is a more flexible plan than a DMO, but not as flexible as a dental reimbursement
plan. As with a medical PPO, you may use a network dentist or an out-of-network dentist.
If you use a network dentist you will receive a higher level of benefit. However, you may
use out-of-network dentists and pay the difference between the amount charged by the
dentist and the reimbursement from the plan. There is no paperwork if you use a network
dentist and you will not be subject to reasonable and customary limits. If you use an
out-of-network dentist you must file the claim and pay any difference between what the
plan pays and the dentist charges. There is usually a deductible that must be met before
any payment will be made by the plan. Coverage is normally 100 percent for preventive care
and either 80 percent or 50 percent of other services.
Dental care is important to your overall health. Over the years,
dental plans have begun to look much like health plans. Dental coverage is second only to
health plans as the most commonly offered and appreciated health-care benefit. Employers
may offer dental 