How Does Dental Indemnity Insurance Work?

A dental indemnity insurance plan is the option most like "true insurance" - that is, it is most similar to traditional health insurance plans. It is a fee-for-service plan that does not use networks, so patients can visit any dentist. After you have paid your deductible, the insurance company will pay all or part of your "usual and customary" dental care costs.

"Usual and customary" is a very important bit of wording! It is the insurance company, not the individual dentist, who decides what are "usual, customary and reasonable" rates using a UCR fee schedule. If your dentist charges more than what the insurance company has determined is "usual and customary," you will usually be responsible for paying the difference. Fee schedules can vary significantly by region and by insurance company.

Dental insurance programs offer different levels of coverage for different types of dental care. A program's coverage is often expressed as three different percentages. For example, a 100-80-50 dental health plan would cover the following:

• 100% of preventative and diagnostic services (cleanings, regular exams, and x-rays)
• 80% of basic dental care and restorative services (basic dental fillings)
• 50% of major services (bridges, crowns, dentures, etc.)

Dental insurance plans also have annual maximum benefits, usually between $1,000 and $2,000. This is the maximum amount the insurance company will pay out for dental care in one calendar year. Since complex dental restorations can cost thousands of dollars, even patients with insurance can end up paying for much of their care.