Dental insurance is a type of insurance in which the beneficiary and the policy provider agree on a plan in which the policy provider pays for the dental services used. This dental service can be from the dentist, dental hygienist or any other person involved in dental health. In exchange for the insurance the beneficiary has to pay the annual premium, co-payment, deductible, etc.
Dental insurance is broadly divided into two types based on the restrictions for the physicians that can be sought, the payment method to the physicians, etc. these two types are: Fee for service plan and the Managed care plan. These types of plans are more or less similar to the general health insurance.
Fee for service plan:
In the fee for service plan the beneficiary is supposed to pay for the services he has taken every time he / she takes those services. The beneficiary can choose any of the doctors or the health care providers by himself and then submit the claim to the insurance company. This is further subdivided into reimbursement plans and the indemnity plans. In the former, you will claim for the bills incurred while having services from the dental health care provider. This claim will be reimbursed irrespective of the type of services sought. In the latter, you will be reimbursed based on the based on the set amount that the insurance company gives for the specific service. In both of the cases it is you who is going to decide who should your doctor be.
Managed care plan:
In this type of plan the insurance company will decide who is going to be your doctor or health care provider. Financial incentives are provided to the beneficiary to get registered in this plan. Financial incentives are provided to the health care professional so that the beneficiary uses these services to the minimum. This is further subdivided into Preferred Provider Organization (PPO) and the Capitation Plan. In the former, there are a group of dental health care providers among which you have to choose one to get the services. It is beneficial for the insurance companies because it is quite easy to manage a small no. of professionals. The capitation plan means that a professional is given the responsibility of both the curative and the preventive dental health services of a certain group of potential patients. The less the services utilized, in other words the better the preventive services the better it is for the professional. The patient is charged in both the cases a capital punishment for utilizing the services of a health care provider outside the plan.
Coverage and payment
The claim is given to the insurance company directly by the claimant of or by the health care provider. Some of the claim is given full but for the most of them partly reimbursement is made. Many insurance companies also keep a cap of certain amount above which the beneficiary has to pay by his / her pocket.
From the above discussion it is quite clear why most people prefer the fee for service plan as it gives them freedom to choose the dental health care professionals.
0 comments:
Post a Comment