What Is Indemnity Dental Insurance?
Dental insurance plans come in two main types. One type is called “fee for service” and one is called “managed care.” Indemnity dental insurance plans (also known as “traditional” plans) are a type of fee for service plan.
With this type of plan, you have the freedom to visit any dentist. With this type of plan, you must pay for services in full and send a claim form to the carrier to be repaid.
Those who subscribe to this type of plan (members or patients) must pay for work in full and then submit a claim to the carrier to be repaid. The payments may be made to the plan member or to the dentist.
Thus, those with indemnity plans pay more out of pocket. On the other hand, compared to managed care plans, they have a broader choice of dentists to work with.
Indemnity Dental Plans and You: What to Consider
Indemnity plans usually pay only a share of the total cost for a given type of work. In addition, the plan’s providers place a ceiling or top limit on how much they will pay for each type of work. Thus, if you have an indemnity plan, you should complete a pre-claim before you have major work done. That way, you’ll know how much the plan will cover before the work is done.
A concept known as a usual, customary, and reasonable fee (UCR) is used to set the top amount the plan will pay. Be sure to note what share of the “customary fee” a plan will pay.
The share an indemnity plan will pay for work will most often be found in the plan’s fee schedule. This may or may be the same as the fees charged by your dentist. When the dentist’s full charge and the share paid by the plan differ, more often than not you have to pay the difference. Dental work can be very costly, and fee schedules change from time to time.
Lastly, note that indemnity plans require a deductible and have a waiting period before certain types of work are covered.
Get to know a few of the dental insurance terms that are used most often.
Summary of Indemnity Dental Insurance Challenges and Strengths
Indemnity Dental Insurance Challenges:
- With this type of plan, you must pay for services in full and send a claim form to the carrier to be repaid.
- The plan pays for work only after the carrier receives and reviews the bill. This means that patients pay more out of pocket.
- What is “usual” or “reasonable” is set by your dentist. The amount deemed “customary” is set by the plan. These two numbers do not always match.
- If the dentist’s full charge and the amount paid by insurance are not the same, you will need to pay the difference.
- These plans require a deductible and have a waiting period before the plan will pay for certain types of work.
Indemnity Dental Insurance Strengths:
- This type of plan lets you choose a dentist from a larger pool than managed care plans.
- These plans usually cover a large part of your bill.
You may complete a pre-claim before you have major work done so you will know up front how much the plan will pay.
Shop for Indemnity Plans
DentalInsurance.com offers indemnity plans from the following carriers:
- American National Life Insurance Company of Texas
- Delta Dental Insurance Company
- Nationwide Multiflex Dental
- Ameritas Dental Insurance
Learn more about the various types of dental insurance plans.