Ch 6 Dental Insurance Flashcards
Benefits paid without any deductibles or co-pays to satisfy
First dollar benefits
A principle which states that an insured cannot profit from reimbursement for a loss
Indemnity
Also known as comprehensive; benefits are paid on a reasonable and customary basis and are subject to deductibles and coinsurance
Non-scheduled plan
Also known as basic; pays benefits from a list of procedures up to the amount shown in the schedule
Scheduled plan
_________________ differs from medical expense insurance in that it is diagnostic and preventative.
Dental insurance
Scheduled plans =
no coinsurance or deductible’s
non-scheduled plans =
coinsurance and deductibles
Health insurers must offer pediatric dental coverage (for children 18 or younger) as an essential health benefit under a health plan or as a stand-alone dental plan.
True
Scheduled plans
- Benefits are paid from a list of procedures
- no coinsurance or deductible’s (first dollar benefits)
Non-scheduled plans
- pay on customary basis
- subject to deductible and coinsurance
- diagnostic, basic services, major services
Benefit categories
- Diagnostic/ preventative
- Basic services
- Major services
Deductibles and coinsurance
- deductible amount to 25, 50, 100
- meet each calendar year
- typically do not apply to preventative care
Combination plans
- combination of basic and comprehensive
- Cover diagnostic and preventative services
- fee for other dental services
Exclusions
Cosmetic surgery, denture replacement or duplicates, oral hygiene instruction, Worker’s Compensation covered injuries, government agency provided services
Pediatric dental coverage
- essential benefit of affordable care act for children 18 years of age or younger
- available on qualified health plan, standalone plan, or contracted/bundled plan
What feature is unique to dental insurance plans?
the inclusion of diagnostic and preventive care.
Under what type of treatment are fillings or crowns used to return natural teeth to functional use?
Restorative
What type of plan would pay benefits on a reasonable and customary basis?
nonscheduled plans
