The Workings of PPO Dental Insurance Plans.
When buying a dental PPO insurance plan understanding how it helps to reduce your dental care cost is important in buying the correct dental insurance plan for you and or your family. PPO Dental insurance plans are based on a cost sharing concept. That is where both you and your insurer pay a certain percentage of the cost for the dental procedure you receive. There are three main categories of procedures and they will normally have different cost sharing breakdowns.
1) Diagnostic/Preventative Services: Under this category it will normally include oral exam, some x-rays and your basic cleaning. Cost sharing coverages will very depending on the plan but typically the insurer pays 80 to 100 percent for these types of procedures and you pay 20 to 0 percent.
2) Basic (Restorative) Services: Under this category it will normally include silver (some limited resin) fillings for cavities, Simple tooth extractions and re-cementing of existing crowns and bridges. Cost sharing coverages will very depending on the plan but typically the insurer pays 80 percent for these types of procedures where as you pay the remaining 20 percent.
3) Major Restorative Services: Under this category it will normally include, crowns, partial and complete dentures, as well Endodontics (Pulpal therapy and root canals), Periodontics (Treatment of diseases of the gums), and Oral Surgery (Extractions and other oral surgery including pre and postoperative care) Cost sharing coverages will very depending on the plan but typically the insurer pays 50 percent for these types of procedures and you pay the other 50 percent.
Some PPO plans may offer a fourth category called Corrective Services: This generally includes orthodontia (braces). Cost sharing will very and can be limited in coverages.
It is important to know that some PPO cost sharing can also be based on a first, second and third year bases where as each year the company increases their coverages to pay out more until the third year where it then stays the same for as long as you may continue to have the plan.
