Our Dental Plan provides benefit to the consumer even if we don’t pay anything because of waiting periods not being met or if the client exhaust the Calendar year maximum. It also provides a benefit to the consumer IF they go to a provider who is not in the network.
By offering Pre-Negotiated rates based on procedures performed in the providers zip code. They are not discounted rated based on some made up %. The Benefit schedule provides the insured the amount the procedure will cost IF that provider is in the network since we pay the benefit based on where the provider’s office location.
If the provider isn’t in the network, the insured can use that list as a tool to negotiate with their provider. And if there are any benefits payable having met the waiting periods, we pay the amount listed in the schedule whether or not the provider is in the network, so they are getting the same benefit as if they were in network! In that situation, the only difference is they will be responsible for the additional charges by the provider.
And the plan pays for 2 diagnostic and preventative visits by each family member per calendar year. That includes:
- Diagnostic & Preventive Services paid at 100%
- No Waiting Periods