Dental Insurance

Question 1

Which of the following types of dental insurance plan is characterized in part by the fact that dentists are effectively prepaid for the care and treatment they provide patients under the plan?

• a preferred provider organization dental plan
• a direct reimbursement plan
• a dental maintenance organization
• idemnity plan

Answer 1

a dental maintenance organization

Question 2

Ron is covered under a group dental insurance plan through his employer. His plan requires that he use a dentist who is specifically listed in the plan. The dentist he chooses will be compensated for care rendered to Ron by a flat per capita fee paid by the insurer and by a co-payment fee paid by Ron with each visit. This type of plan is most likely

• an exclusive provider organization
• a dental health maintenance organization
• an indemnity plan
• a preferred provider organization

Answer 2

• a dental health maintenance organization

Question 3

Joni is covered under a dental insurance plan that requires her to annually pay the first $200 of dental expenses (other than routine semiannual examinations and cleanings, which are covered in full), at which point the plan reimburses her for 80% of the cost of routine care. Joni is most likely covered under

• a dental maintenance organization
• a comprehensive plan
• an exclusive provider organization
• a capitation plan

Answer 3

• a comprehensive plan

Question 4

Most dental insurance plans control costs by all of the following means EXCEPT

• limiting the dollar limit on the benefits an insuraed can receive in 1 year
• eliminating all coverage for specified time periods
• limiting the type of services that the plan will cover
• limiting the number of services that the plan will cover

Answer 4

• eliminating all coverage for specified time periods

Question 5

One charalecteristic that the capitaion, schedule of allowances, and usual, reasonable and customary methods of dental benefit determination have in common is that all 3 methods

• are available only with indemnity plans
• generally involve high deductible and coinsurance requirements
• require that the insured select a dentist from a specific list of approved providers
• determine benefits on some form of scheduled basis

Answer 5

• determine benefits on some form of scheduled basis

Question 6

In a typical dental plan, one might expect all of the following types of treatments or procedures to be covered as routine care EXCEPT

• protective fluoride treatments
• semiannual oral examinations and teeth cleaning
• local anesthestics
• orthodontics

Answer 6

• orthodontics

Question 7

Jennifer’s dental plan covers routine dental care at 80% (after the deductibles, but major dental care at 50%. Which of the following types of dental treatment would most likely have a 50% coinsurance requirement?

• scaling of the gums to treat a gum infection
• repair of dentures
• a stainless steel crown
• creation of a fixed bridge

Answer 7

• creation of a fixed bridge

Question 8

Which of the following statements pertaining to dental insurance is NOT correct?

• dental insurance is generally available in group plans, but seldom in individual policies
• a maximum dental benefit is usually specified for a calendar year
• benefits are normally payable for most dental work, including cleanings, fillings and extractions
• dental coverage usually includes a deductible provision, but not a coinsurance feature

Answer 8

• dental coverage usually includes a deductible provision, but not a coinsurance feature