What is the level of coverage?
When shopping out dental PPO’s and Indemnity insurance plans you will want to know the level of coverage’s the plan is offering. Usually dental insurance benefits are broken down into four categories:
* Class I or Preventive Care: Under preventive services you will normally see basic cleanings, exams and x-rays and space maintainers
* Class II or Basic: Under basic services you will normally see fillings and recementation of crowns or bridges
* Class III or Major: Under Major dental service you will normally see Oral Surgery, Endodontic Treatment of Disease, Periodontic Services, Crowns, Denture and Bridge Repair
* Class IV Orthodontics – If provided. Note: not all PPO’s or Indemnity dental insurance plans cover for Orthodontic services. If they do note any age restrictions as often time it will only cover children up to age 19
Typically, these plans will cover Class I at around 80/100%, Class II at 80%, and Class III at 50%. Orthodontics are not always covered, but when it is, the coinsurance is usually 50% up to a certain lifetime maximum.
Normally payment is based on the company’s UCR (usual, customary and reasonable) fees. These fees vary amongst each insurance company and may not always match up to a provider’s fee schedule, especially if you choose to go outside the plan network of providers.
Remember coverage’s will very depending on each plan some plans if a first second and third year schedule increasing your benefits the longer you have the plan. Make sure to read each plans terms and conditions carefully so you buy the plan that best fits your dental care needs.