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Indemnity
Use any dentist; insurance carrier pays claims.
Typically: 100% Preventive services; 80% basic services; 50%
major services; $50 deductible (for basic & mjor services
only); $1000 maximum/year.
Dental Health Maintenance Organization (DHMO)
Capitation / Reduced Fee
Must use participating dental offices. These offices have
agreed to charge members reduced fees for covered services.
There are usually no claim forms, deductibles or maximum benefit
limitations. Member pays dentist the contracted reduced fee.
Generally the lowest cost dental option available.
Preferred Provider Organization (PPO)
Use participating dental offices that have agreed to charge
specified fees, thus reducing your out of pocket expense.
Insurance carrier pays claims. You still have the option of
using a non-PPO dentist.
Direct Reimbursement
Use any dentist. Employer reimburses employees dental bills
based on a schedule of payment. Typical schedule: 100% of
first $100; 80% of next $500; 50% of next $1000. Can be administered
in-house or by a Third Party Administrator (TPA). We provide
direct reimbursement administrative services.
Dual-Choice
Employees have the choice between DHMO and PPO or indemnity
plan.
Self-Funded
Employer offers indemnity type coverage and assumes the risk
of paying claims. Can be administered in-house or by a Third
Party Administrator (TPA).
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