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Dental Insurance: Types Of Policies, Including Benefits

Benefits Under An Indemnity (fee-for-service) Dental Plan

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Benefits are divided by the type of dental care. As a general rule, the earlier the treatment, the broader the benefits.

Preventive: The goal is to get people to have regular check-ups and cleanings so that there will be no need for more serious (read expensive) dental work. Because of this, most dental plans offer broad preventive benefits. Typically, there is no deductible, and 100% coverage for prophylaxis (cleanings), check-ups and x-rays. This coverage is usually limited to two cleanings and check-ups per year with x-rays limited to once every one or two years.

Restorative (or Basic): Restorative benefits usually have an annual deductible of $50 - $100 after which the plan pays a percentage (usually somewhere between 70% and 90%) of the "Usual, Customary & Reasonable" charges. (For a description of "usual, customary and reasonable, look at the discussion concerning health insurance by clicking here. The concept is the same.)

Replacement (or Major Services): Replacement benefits often share deductibles with Restorative charges, so if you've met the deductible for either service, the other is also covered. Replacement coverage co-insurance is generally different from the restorative percentage, frequently in the neighborhood of 50%. Occasionally there will be a one year waiting period before Major Services are covered.

Annual Maximum Benefit: Dental plans generally have a maximum annual benefit in the ball park of between $1,000 and $2,500. The maximum will apply to all charges.

Orthodontia: Orthodontia is often excluded from dental coverage. When it is offered, it is usually a small amount such as 50% of charges to a maximum of $500 or $1,000 per person.

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