Benefit Specialists of NY

Dental Coverage

In today’s tight job market and booming economy, attracting and keeping quality employees is getting more challenging. Since employees—both current and prospective–use a company’s benefit package as a key barometer to judge how it values employees, dental coverage can be an inexpensive investment in your company.

Four levels of treatment to fit your needs

Preventive: Usually provides for an exam every six months, x-rays, prophylaxis, fluoride treatments, sealants and spacers (certain limitations apply).

Basic: Usually includes fillings, extractions, oral surgery, root canal, periodontics and repairs to crowns.

Major: Coverage usually includes crown, inlays, porcelain restoration, endodontic, full and partial dentures, certain adjustments, bridges, repairs and non-surgical TMJ treatment.

Orthodontics: Coverage is typically for dependents up to age 19.

Plan Options

Benefit Percentage: Choose percentage of reimbursement – 50%, 80% or 100%.

Benefit Maximum: Choose the annual maximum such as $750, $1,000 or $1,500.

Waiting Periods: Choose any period such as six months or one year on selected services.

Indemnity, PPO or DMO: Choose the style of dental plan from Indemnity, Preferred Provider Organization or Dental Management Organization.

The coverages detailed here represent a partial list of all coverage available. Please contact a Benefit Specialists of NY representative today to discuss the full list of coverages, limitations and exclusions.

Dental Glossary

Indemnity
Generally covers bills from any participating provider. Some services are subject to annual deductible and coinsurance. Typically has broad coverage, high lifetime limits and freedom of choice of doctors. May have to submit claim forms and wait for reimbursement. Does not encourage preventive care like HMOs.

Preferred Provider Organization (PPO)
A looser form of Managed Care (weak gatekeeper concept). Establishes a network of providers who agree to supply care at discounted rates. Members pay a small co-payment (no deductible or coinsurance) when utilizing a network provider. PPOs also allow members to utilize non-network providers, but must pay deductibles/coinsurance similar to indemnity plans. There is no requirement to designate a primary care physician and no claim forms when utilizing the network.

Dental Management Organization (DMO)
The dental version of an HMO. The insurance carrier contracts with a list of providers at a set fee schedule. Members pay a co-pay for each service, with no deductibles or coinsurance.