Dental Insurance Cincinnati

At McCarthy Stevenot we offer a variety of dental insurance and pre-paid dental plan options for groups and individuals.

Request Quotes and Information on dental plans in Cincinnati and northern Kentucky:

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Learn More About Dental Insurance

Dental Insurance or other types of Dental Plans can be available for groups and individuals. There are five basic forms of dental insurances and /or dental plans.

Discount Plans

These types of dental plans are not technically a dental “insurance” per se as benefits are paid for directly by the subscriber (individual patient). Discount plans charge a fee that pays for the operation and administration of the plan itself. Dental providers agree to a fee schedule set by the discount plan and subscribers access those providers for care. Fees for services are billed to the subscriber at the discounted rates set forth in the dental discount plan.

Pre-Paid Dental Plans

A pre-paid dental plan more closely resembles a traditional dental insurance plan. Pre-paid dental plans contract with dental providers to perform services for plan subscribers. The plans reimburse dental providers for services provided and charge co-pays or coinsurance percentages to plan subscribers. Dental plans of this type are commonly “closed network” plans. A closed network plan is a plan that provides coverage only for services rendered from contracted providers. If a subscriber patient sees a dental care provider that is not listed in the plan network, there may be little or no coverage available. Referrals to specialists are typically not required.

Dental HMO Plans

Similar in nature to Pre-Paid Dental Plans, Dental HMO Plans (Dental Health Maintenance Organizations) operate under closed networks. Dental providers are selected by subscribers during enrollment and providers may paid a small fee per month/ per person subscribed. Basic fees are covered via this monthly per person (or capitated) fee. Additional services may be billed as fee for service. Usually referrals are required for specialist coverage.

Dental PPO Plans

A Dental PPO (Preferred Provider Organization) plan has “in” and “out” of network components. When subscribers access dental providers that are listed as “in network,” dental services are paid a higher rate of reimbursement than when a subscriber is treated from a non-contracted dental provider. Out of network treatment is still covered, but with higher co-pays and generally higher out of pocket maximum expenses. Referrals to specialists may or may not be required, depending on the plan selected.

Traditional Dental Plans

A Traditional Dental Plan has no network associated with the plan itself and subscribers may seek services from any dentist they choose. The plan reimburses the insured subscriber for care based on the usual customary and reasonable expenses stipulated in the dental plan contract. In the event a dental care provider charges a higher fee for services than the contract stipulates, the patient may be “balance billed” for the difference. Balance billing occurs commonly in traditional dental plans as well as on the out-of-network side of Dental PPO Plans.

Annual Plan Maximums

Most dental insurance plans will specify an annual maximum benefit for services provided under the plan. A typical annual maximum might be $1500 per calendar year. This maximum specifies the most the plan will pay in total benefits for a plan year. Some individual services may have a different annual or lifetime maximum per covered subscriber. For example, orthodontia may have a separate lifetime maximum benefit per covered subscriber.

Types of Services Covered

Dental plans typically reimburse at different rates for different types of service. Plans also define what types of services fit into each category. Basically there are three types or categories of dental plan services:

Preventive Services

Preventive services refer to basic oral exams, cleanings and /or screenings. Depending on the services offered, there may be extra charges for specific preventive services such as x-rays or fluoride treatments. Plans may have varying degrees of coverage for items such as tooth sealants to prevent tooth decay (especially in children). Most plans favor richer levels of benefits for preventive services because preventive dental care seems to head off many dental problems that would otherwise become more complicated 9and more expensive) if left untreated.

Basic Services

Basic dental services refers to basic restorative dental services. A simple filling or filing repair is an example of a basic service.

Major Services

Major dental services refers to major restorative dental care. Bridges, Crowns, Inlays and tooth implants are examples of major dental services.

Request more information on dental plan options for individuals or groups by submitting information at the top of this page.

Individuals can use the submittal form provided. Groups should download and print out a group dental request PDF form and fax to our agency at 513-891-3088.

Filed under: Dental Insurance Buyer's Guides

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