James W. Goodacre II offers a full selection of individual and family dental insurance and group dental insurance. Dental Insurance is the second most common employee benefit next to medical in most businesses. There are four broad types of dental plans to chose from. They are Dental Health Maintenance Organization (DHMO), Indeminity Dental Plans, Preferred Provider Organization (PPO) Dental Plans, and Scheduled Dental Plans.
Dental Health Maintenance Organization, DHMO
Dental Health Maintenance Organization or DHMO are one of the most affordable types of dental insurance plans around. Dental services are provided by professional dentists who agree to provide certain treatments and services to patients at no charge. There may be a co-payment for some services.
The philosophy behind DHMO plans is to incent dentists to keep patients in good health through affordable prevention services so plan costs are kept low. A participating dentist is paid directly by the insurance company for each individual or employee, independent of how often covered services are used.
Indemnity Dental Plans
Indemnity dental plans offer the greatest choice for dental services to the individual or employee. These plans generally pay a portion of the dentist's fee or a set dollar amount, usually the lesser amount..
The individual or employee covers the difference of the dentists full charge and what the plan pays for that dental service. Payment for services can be made to the insured person or assigned to a specific dentist so the dentist is paid directly.
Preferred Provider Organization, PPO Dental
Preferred Provider Organization PPO dental plans are one of the most popular types of dental insurance in the market. Typically less expensive than Indemnity dental plans. Individuals or employees that use a PPO select their dentist from a PPO network or listing of dental providers who have agreed by contract to a reduced fee for services structure.
Individuals and employees have the choice to receive treatment from dentists outside of the PPO (non-participating dentists). They would be responsible for higher deductibles and/or co-payments.
Scheduled Dental Plans
A scheduled dental plan a.k.a. scheduled reimbursement plan, helps pay for a significant portion of certain dental procedures. These plans reimburse you for a specific amount based on a fee schedule with any balance due being your responsibility. Scheduled plans are structured so you have
- a calendar year maximum
- a deductible
- waiting periods on certain procedures.
Every covered procedure and the amount you will be reimbursed for each procedure is detailed in a schedule plan. . For example, if the insurance reimburses $43 for a cleaning, and your dentist charges you $50 for a cleaning, you would be responsible for the difference of $7.
Please contact me via email James Goodacre, or call us at 831-626-9250. We can discuss the various dental insurance options for you or your company.