PPOs and Indemnity Dental insurance plans have a three level/tier system.
The first tier or level consists of preventive services, such as examinations, cleanings, fluoride treatments, space maintainers for children, and pit and fissure sealants to help prevent decay in biting surfaces of back teeth. Basic services usually don't require a deductible and are covered at 100 percent.
The second tier or level consists of basic services. These dental treatments are of relatively simple complexity or do not involve significant extra expense to the dentist. Examples include, fillings, routine extractions, and single crowns. Most plans will require you to pay anywhere from 20 - 50 percent.
The third tier or level consists of major services. Examples include fixed bridges, removable full dentures, or periodontal surgery. Most plans will also require you to pay anywhere from 20 - 50 percent.
Here are some questions to ask if your employer offers more than one dental plan, or you are looking to purchase an individual dental insurance plan:
1. Are there any maximums?
2. What are the deductibles?
3. Do I have to fill out claim forms?
4. Are there any waiting periods?
5. Does the plan cover preventive, basic, and major services?
6. How much do I have to pay for using non-preferred providers?