Index | Dental Insurance | Indemnity Insurance Plans
Indemnity Insurance Plans
An Indemnity Insurance Plan, also often referred to as a traditional dental coverage plan or a fee-for-service plan, is a type of dental plan that provides preventive, basic, major restorative and orthodontic dental coverage. There are special features of Indemnity Dental Insurance Plans that relate not only to the nature of dental care you need, but also to advantages and disadvantages of coverage. Thus, with an Indemnity Insurance Plan you will be able to select the specialists you want to see. In comparison with other plans working only with participating dentists, this type of a dental plan thus allows a greater flexibility in the selection of providers. Just imagine that travelling is your lifestyle and you are constantly on the move, or you have to travel on business, or your family situation requires you to move from place to place. Indemnity Insurance is the right kind of Dental Insurance for you - you can apply to any professional wherever you are, not thinking that this specialist may not belong to the network of providers. At that you do not need any referral or authorization to see a dentist.
Another special feature of this plan concerns the operational efficiency of reimbursement. You should know that with this plan you will have to pay for dental care out-of-pocket and only then you may submit claim forms to your insurance provider. Your provider will reimburse you for either part or all dental care expenses depending on the conditions stipulated in your contract. Usually insurance providers reimburse from 70% up to 100% of the "usual, customary and regular" (UCR) costs. On average, the preventive procedures are reimbursed at the rate of 70-80%. For more complex procedures the rate of reimbursement may be lower, or your plan may not cover certain services at all.
There is, however, a chance that your provider may disagree with your claims and refuse to reimburse your dental care expenses. The situation is fraught with a lot of paperwork and you may have to file a number of claims and complaints. That is why you should know that Indemnity Insurance Plans normally cover only the charges which are medically necessary, i.e. appropriate and consistent with the medical diagnosis. There can also be exclusions in your policy - the expenses that an Indemnity Insurance Plan may initially not cover.
Under Indemnity Insurance Plans you are required to pay a deductible. The costs associated with this dental plan change periodically. Therefore, you are recommended to check out all the conditions, provisions and exclusions before purchasing a plan of the type as well as to carefully study what services you will be reimbursed for and at what rate.
The range of services provided under Indemnity Insurance Plans vary, but typically include regular checkups and cleanings, as well as fillings, root canals, tooth extractions and other basic dental work meant to prevent and cure tooth and gum diseases. It is important to read the contract carefully and learn beforehand what services are covered by the policy. If you require treatment that is beyond the limit, you will have to pay out-of-pocket. Therefore, it makes sense to study the available Indemnity Insurance Plans and choose the one with a high limit. In this respect some Indemnity Insurance Dental Plans offer a maximum level of out-of-pocket costs benefit. If you have reached this yearly limit, your insurance provider will take the responsibility to cover all the UCR costs for your dental treatment.
Usually Indemnity Insurance Plans make use of UCR fee schedules, which means that you can tailor your needs and your expenses to advantage. The underlying principle is the higher the dentist's charges the less money you will receive as reimbursement. That is why when choosing an Indemnity Insurance Plan you can be guided by the UCR fee schedule in your area.
With some Indemnity Insurance Plans you can provide coverage for your eligible dependents (such as "Employee + Child", "Employee + Spouse" or "Family" plans). There should be a special provision stipulating this option and you should qualify for it.
One more feature of Indemnity Insurance Plans is related to waiting periods. Normally you are enrolled in a dental care plan for a waiting period of some months (about 6 months or more). With an Indemnity Insurance Plan you may have the privilege of shorter waiting periods.
Indemnity Insurance Plans are often used to cover groups, such as a group of employees. This is the most expensive type of Dental Insurance for a company to offer since an employee with Indemnity Insurance may choose any dentist and then submit his indemnity claim. And the insurance company should be able to reimburse at least part of the expenses.
Like any other types of insurance contracts, Indemnity Insurance Plans have their advantages and disadvantages. Most dentists accept patients with this plan and it is an indubitable advantage. The other side of the coin is that the dentist will most likely charge you a high price. When making your choice, remember that a reasonable decision is an informed decision.