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
