Dental insurance is misnamed. Dental benefit is what it should be called. It's easy to see why. Dental care is usually predictable, involving primarily checkups and cleanings. It is usually not catastrophic, like a major medical expense. The average dental claim is less than $100. On this page, you will find information on individual and business dental plans, and the unique dental benefit Direct Reimbursement, which helps businesses control costs and offer freedom of choice.
The Georgia Dental Association is not currently aware of any traditional indemnity insurance plans available for direct purchase by individuals. The GDA encourages patients to discuss payment options with their dentist of choice. To find a GDA member dentist in your area, click here.
Dental Plans for Businesses
There are several types of dental plans available:
Direct Reimbursement is not dental insurance. DR is a dental benefit which allows businesses to give employees freedom of choice, control plan benefits, and self-fund dental coverage. Self-funding means employers can save most of the traditional outside administrative fees and apply funds directly to employee dental treatment. For more information on starting a DR plan in your company, email layfield@gadental.org.
How DR Works: The patient selects a dentist and receives treatment. The patient pays the dentist. If the patient pays the dentist directly, the employee submits a receipt to the business and receives reimbursement and an explanation of benefits. If the plan allows assignment of benefits, the claim is sent to the payer, and the dentist receives payment. The patient's portion is collected by the dentist at the time of treatment.
Administration: The plan can be administered in-house or a third party administrator for a fee. Employers determine the annual maximum and reimbursement formula for expenses incurred. Reimbursement to the patient, or to the dentist if assignment is chosen, comes from a fund established by the employer using employer and/or employee contributions. The patient's financial responsibility varies depending upon their plan co-payment level and annual maximum.
DR Advantages: There is no need for pre-determinations, prior authorizations, or procedure based denials. The dental plan design limits the reimbursement amount through co-pay levels and annual maximums. The plan can be designed so that the employee pays 10 percent to 40 percent of all charges. Employers gain savings, control over plan design, employee satisfaction, more dollars going to care, and employee loyalty from use of employer funds to pay benefits. Employees gain freedom of choice of dentist, easy to understand benefit plan, typically no exclusions, and an easy to calculate benefit.
Indemnity coverage places dental procedures into categories. Each category provides coverage at different percentages. After meeting a required deductible, the plan pays either a set percent or the amount of the treatment charge determined by the plan to be customary. Typically, the patient pays any remaining balance. The customary limit may not accurately reflect the standard treatment charge of dentists in an area. This doesn't mean that dentists overcharge for treatment. A drawback to this type of plan is that it can exclude certain procedures. However, indemnity plans allow patients to see the dentist of their choice.
A PPOs is a type of managed care organization which contracts with an insurance company to provide dental care to insured persons at discounted fees. Under a PPO plan, you may choose only from dentists in a plan. If you see a dentist not in the plan, your benefits may be reduced or eliminated.
An HMO is also a type of managed care organization. Under HMO plans, contracted dentists typically agree to provide specific types of treatment to HMO members at no charge. For some types of treatment, however, patients must pay a co-payment. Charges for other types of treatment may not be covered. Some patients may experience difficulty scheduling timely appointments if contracted dentists are busy, or if a plan's contracted dentists are not close by a patient.
