Group dental insurance 101

Posted by Nick Niesen on October 29th, 2010

Even if you get insurance as part of a group you essentially enjoy the same benefits that an individual dental insurance plan provides with an added advantage. Because you are part of a group, you pay lower premiums.

Dental insurance carriers prefer to insure groups because the risk is spread around and more members in the group guarantee them additional business.
Many companies and unions offer this benefit to attract and keep good employees. The effect is very positive effect. This is to lighten the financial load of the employee by paying for a portion of their dental plan.

As a member of a group, your dental insurance plan is a result of a contract between your employer (or union), or plan sponsor, and a third party (insurance company). Any your concerns you have regarding your plan coverage should be directed to the plan sponsor or your employer.

To maximize the benefits found in your dental plan you should take time to know how it is designed and what its limitations are. A good group dental plan is one which covers around 60 to 80 percent of each dental treatment you undergo.

Some Features Common To Group Dental Insurance Plans

Direct Reimbursement program
Under this plan, the patient can go to their preferred dentist. After treatment patient is reimbursed a portion of the amount spent on dental care, regardless of whether the treatment is a minor or major procedure.

UCR or "Usual, Customary, and Reasonable" program
This design plan offers flexibility because the patient can go to their preferred dentist. The ?reasonable? or ?customary? fee limit is jointly determined by the plan purchaser and the third party payer.

Table or Schedule of Allowance programs
Each covered service is tabled and assigned a specific fee. The amount represents how much the plan pays for the services. Most times, plan does not pay for the entire treatment, and the patient has to pay for the difference.

Preferred Provider Organization (PPO) program
Contracting dentists give a discount on their service fees to attract patients. However, patients cannot avail of these discounts if they choose a dentist who is not part of this network.

Capitation program
The dentist signs a contract with the sponsor of the plan, and provides all or a specific number of treatments covered under the dental insurance program. In return, the dentist is paid a set fee for each patient or subscriber.