Dental
Dental Insurance Information
Our Dental Plan provides benefit to the consumer even if we don't pay anything because of waiting periods not being met or if the client exhaust the Calendar year maximum. It also provides a benefit to the consumer IF they go to a provider who is not in the network.
HOW?
By offering Pre-Negotiated rates based on procedures performed in the providers zip code. They are not discounted rated based on some made up %. The Benefit schedule provides the insured the amount the procedure will cost IF that provider is in the network since we pay the benefit based on where the provider's office location.
If the provider isn't in the network, the insured can use that list as a tool to negotiate with their provider. And if there are any benefits payable having met the waiting periods, we pay the amount listed in the schedule whether or not the provider is in the network, so they are getting the same benefit as if they were in network! In that situation, the only difference is they will be responsible for the additional charges by the provider.
If the provider isn't in the network, the insured can use that list as a tool to negotiate with their provider. And if there are any benefits payable having met the waiting periods, we pay the amount listed in the schedule whether or not the provider is in the network, so they are getting the same benefit as if they were in network! In that situation, the only difference is they will be responsible for the additional charges by the provider.
And the plan pays for 2 diagnostic and preventative visits by each family member per calendar year. That includes:
Diagnostic & Preventive Services paid at 100% No Waiting Periods
Examples of Diagnostic & Preventive Services when receiving benefits through PPO
Routine oral exams-1 exam per 6 month period
Bitewing X -ray (up to set of 4)-1 set per Calendar Year
Full Mouth X-ray (Panoramic Film or Full Series)- no less than 36 months apart
Prophylaxis (cleaning and scaling of teeth)- 1 per Calendar Year
Topical application of Fluoride for dependent children under 19-1 per Calendar Year
Consultation- other than treating doctor
Comprehensive Oral Exam
Sealant- dependents under 14, one treatment per tooth no less than 36 months apart
Space Maintainers- the initial appliance for dependent children under 13, including adjustments within the 6 month period immediately following installation
