A dental HMO plan will usually provide the most comprehensive level of benefits with the lowest share of cost to the insured. Routine check-ups and other preventive dental treatments may be covered in full or require a small co-payment. Dental HMO plans are also referred to as capitation dental health insurance plans. These types of plans will pay the participating dentist a set monthly capitation fee for accepting you as his dental patient. He receives this fee whether he sees you during the month or not.
Unlike a traditional dental insurance plan or a PPO dental insurance plan, the HMO dental plan will require you to choose one dentist as your primary dentist. You will be required to use this same dentist for all your dental treatments. If your needed dental care goes beyond the capabilities of your dentist, he may refer you to a specialist with whom he has a referral agreement. This specialist may or may not accept the benefits of your HMO dental insurance plan. For this reason, it is important to select a dentist that works with specialists that will also recognize the covered dental insurance benefits of your dental plan. Dental treatments that are not covered under your dental HMO plan will be outlined in the dental insurance exclusions portion of your policy.
Your Dental HMO plan will provide you with a schedule of benefits and your co-payment for each of these listed benefits. The co-payment is the amount that you will pay directly to your dentist at the time you receive the dental treatment. Preventive treatments, such as check-ups, cleanings and x-rays are usually performed at no charge to you. This is to encourage you to seek regular check-ups in order to prevent more complicated dental problems in the future.
When considering a dental HMO plan, make sure that there are dentists in your area that accept this HMO plan. The insurance company should provide you with a list of all participating HMO dentists in your area. You may find that many of the dentists in your area will not participate in or accept your HMO dental plan. A dentist may initially accept HMO patients when he first begins his dental practice because it will help the him establish a patient base. But as his patient base grows, he may discontinue his contracts with dental HMO insurance companies.
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