Unit 19 - Dental Insurance

Question 1

Types of Dental Treatments

Answer 1

Dental expense plans usually provide coverage for the following types of dental treatment:

• diagnostic and preventative - routine exams, x-rays, regular cleanings, flouride treatments
• restorative - repairing or restoring teeth that have been damaged, usually by tooth decay, fillings and crowns are restorative treatments
• oral surgery - surgery performed in the oral cavity, for example removal of wisdom teeth
• endodontics - treatment of the pulp (the soft tissue substance located in the center of each tooth), root canals
• periodontics - treatment of supporting structures of the teeth, gums
• prosthodontics - artificial replacements, bridges and dental implants
• orthodontics - correction of irregular alignment of teeth

Question 2

Scheduled vs Nonscheduled Plans

Answer 2

Scheduled - benefits are limited to a specified maximum per procedure

Nonscheduled - plans that pay on a usual, customary and reasonable (UCR) basis

Question 3

Combination Plans

Answer 3

Some dental expense plans combine features of both the scheduled (basic) and nonscheduled (comprehensive) plans. They typically cover diagnostic and preventative treatment on a usual, customary and reasonable basis, but use a fee schedule for other dental services.

Question 4

Diagnostic/preventative services

Answer 4

Usually covered without deductibles or coinsurance to encourage preventative dental care. However routine exams and cleanings are generall limited to twice a year and diagnostic x-rays to once every two or three years

Question 5

Basic services

Answer 5

Such as fillings, crowns, and local anethesia may be subject to a deductible and 20% coinsurance or a limit per service in excess of which the insured must pay. There may also be an overall annual limit on benefits for all basic services.

Question 6

Major services

Answer 6

Such as oral surgery, root canals, perodontics, bridges, and implants may be subject to a higher coinsurance rate, such as 50%, as well as per service limits.

Replacement of dentures may be limited to once every five years.

Orthodontia usually has its own seperate deductible, higher coinsurance rate, and annual limit.

Question 7

Exclusions

Answer 7

• cosmetic treatment - teeth whitening, elective treatment
• oral hygiene instruction
• replacement of teeth missing at time coverage became effective
• completion of services begun before coverage became effective
• replacement of lost dentures, duplicate dentures
• occupational injuries covered by worker’s comp
• treatment received in government facilities