Dental insurance is financial coverage for preventative and treatment-based dental health care. A person pays a dental health insurance provider premiums in exchange for guaranteed payments of benefits on covered services. Many people participate in group-based PPO or HMO provider network plans.
Similar to general health care, a PPO plan allows a covered person flexibility to select primary dental providers and specialists based on need. A referral typically isn't needed. In contrast, a covered person must select a primary dental clinic provider with an HMO plan. With an HMO, the covered person is supposed to receive all basic dental care through the primary dentist and get referrals for other network-based specialists.
It is common in a dental insurance plan that different services are covered at different levels. Routine check-ups and cleanings might be covered at 80 percent, for instance, whereas fillings and crowns may receive a different coverage level, such as 50 percent. Most network plans also have an annual deductible for each member as well as a family deductible.
There are also maximum benefit levels at which the provider pays on each person. Dental plans normally pay benefits when a non-network provider is used, but they often pay the contracted rate that in-network providers receive. This factor means the covered person may pay the difference.