Dental Insurance Chapter 19

Question 1

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

A. eliminating all coverage for specified time periods

B. limiting the dollar limit on the benefits an insured can receive in 1 year

C. limiting the type of services that the plan will cover

D. limiting the number of services that the plan will cover

Answer 1

A

Question 2

When a dental insurance plan requires that the insured and her dentist notify the insurer of proposed dental care, its purpose is primarily to

A. give the insurer an opportunity to obtain a second opinion from a dentist of its choosing

B. allow the insurer to determine if the dentist is an approved provider

C. allow the insurer to predetermine and advise the insured of the amount of coverage the plan will provide for the proposed care

D. help the insured better understand and appreciate the full costs of dental care

Answer 2

C

Question 3

Which of the following dental services usually require the insured to pay a deductible or co-payment?

A. oral examinations

B. complete x-ray surveys

C. preparation of retainers and braces

D. topical flouride treatments

Answer 3

C

Question 4

Which of the following statements about dental insurance is not correct?

A. group plans generally offer dental insurance, but individual policies seldom do

B. a maximum dental benefit is usually specified for a calendar year

C. dental coverage usually includes a deductible provision, but not a coinsurance provision

D. benefits are usually paid for most dental work, including cleanings, fillings and extractions

Answer 4

C

Question 5

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

A. benefits are normally payable for most dental work, including cleanings, fillings and extractions

B. a maximum dental benefit is usually specified for a calendar year

C. dental insurance is generally available in group plans, but seldom in individual policies

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

Answer 5

D

Question 6

Dental plans encourage insureds to take advantage of preventive care because

A. this type of care can be performed by a dental assistant, eliminating the need to pay a dentist

B. the insured pays for most of the costs associated with prevention

C. most plans only cover preventive care

D. preventive services can eliminate the need for major, and more expensive, dental work in the future

Answer 6

D

Question 7

Which of the following statements regarding indemnity dental plan exclusions and limitations is not correct?

A. most indemnity dental plans limit the amount of services that are covered within a year

B. elective dental procedures such as teeth whitening are generally not covered under indemnity dental plans

C. the maximum amount of coverage a plan will provide for any given form of dental care is most commonly based on the fees that are deemed usual, customary, and reasonable for the communitys in which the service is provided

D. coordination of benefit provisions is not permitted with dental insurance, and a person may collect full plan benefits from every plan under which she is covered

Answer 7

D

Question 8

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

A. are available only with indemnitys plans

B. require that the insured select a dentist from a specific list of approved providers

C. determine benefits on some form of scheduled basis

D. generally involve high deductibles and coinsurance requirements

Answer 8

C

Question 9

Oral surgery, braces, and implants are all examples of what kind of dental service?

A. routine

B. preventive

C. major

D. elective

Answer 9

C

Question 10

Jack is covered under a dental plan that encourages him to obtain care from a select group of dentists but allows him to get care from any dentist (though the coverage may be less with the non-plan dentists). Jack’s plan is most likely

A. a preferred provider organization dental plan

B. a dental health maintenance organization

C. an indemnity plan

D. a direct reimbursement plan

Answer 10

A

Question 11

Which of the following dental plans covers dental services on a traditional fee for service basis?

A. comprehensive plan

B. preferred provider organization

C. capitation plan

D. direct reimbursement plan

Answer 11

A

Question 12

Which of the following types of dental insurance plan is characterized in part by the fact that dentists are paid a prearranged fee for dental services?

A. an indemnity plan

B. a preferred provider organization dental plan

C. a direct reimbursement plan

D. a dental health maintenance organization

Answer 12

B

Question 13

A dental plan that pays a capitation fee to the dental provider is

A. a dental health maintenance organization

B. a preferred provider organization

C. an exclusive provider organization

D. an indemnity plan

Answer 13

A

Question 14

The typical coinsurance ratio for dental insurance plans is

A. 50/50

B. 80/20

C. no coinsurance

D. 60/40

Answer 14

B

Question 15

Why do dental plans encourage insureds to use preventive care?

A. preventive services can eliminate the need for major dental work (which is more expensive) in the future

B. the insured pays for most of the costs associated with prevention

C. most plans cover only preventive care

D. preventive care can be performed by a dental assistant, which means the insured will not need to be treated by a dentist

Answer 15

A

Question 16

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

A. local anesthetics

B. orthodontics

C. protective fluoride treatments

D. semiannual oral examinations and teeth cleaning

Answer 16

B

Question 17

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. a dental health maintenance organization

B. a capitation plan

C. an exclusive provider organization

D. a comprehensive plan

Answer 17

D

Question 18

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

A. an indemnity plan

B. a preferred provider organization

C. a dental health maintenance organization

D. an exclusive provider organization

Answer 18

C

Question 19

Which of the following types of dental treatment is usually excluded under a dental expense plan?

A. teeth whitening

B. oral surgery

C. orthodontics

D. fluoride treatments

Answer 19

A

Question 20

Routine dental services include all of the following except

A. x-rays

B. gum surgery

C. fluoride treatment

D. cleaning

Answer 20

B

Question 21

Dental insurance plans manage costs by using all of the following measures except

A. limiting the type of services that the plan will cover

B. setting a maximum dollar limit on benefits that the insured can receive during 1 year

C. limiting the number of services that the plan will cover

D. eliminating all coverage for specified periods

Answer 21

D

Question 22

Which of the following statements about comprehensive dental expense insurance is not correct?

A. they usually are subject to coinsurance

B. diagnostic and preventive care are generally not subject to deductibles

C. they are also known as nonscheduled plans

D. they usually pay a fixed benefit dollar amount

Answer 22

D

Question 23

Which of the following statements about dental benefits offered by a preferred provider organization is not correct?

A. in contracting to render services, a PPOs dentists agree to charge less than their usual fees when treating group members

B. rates offered through a PPO are negotiated and save money for the insurer

C. if an insured decides to obtain treatment from a dentist who does not participate in the panel, he usually can receive the same care for the same costs

D. preferred provider organizations offer dental care through a panel of dentists who have agreed to treat a group of insureds

Answer 23

C

Question 24

Which of the following is not considered a routine dental service?

A. x-rays

B. root canal

C. fluoride treatment

D. cleaning

Answer 24

B

Question 25

Dental insurance generally promotes preventive care, and toward that objective it does all the following except

A. usually cover the cost of routine cleanings in full

B. cover up to 2 routine examinations per year, once every 6 months

C. exclude dental care for diseases that could have been prevented with better personal hygiene

D. generally require the insured to cover more of the cost for the treatment of dental disease than for the cost of preventive care

Answer 25

C

Question 26

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

A. scaling of the gums to treat a gum infection

B. creation of a fixed bridge

C. a stainless steel crown

D. repair of dentures

Answer 26

B