This industry underwrites dental insurance policies. Dental insurance helps cover the costs of dental care, ranging from basic preventative coverage to major dental work, depending on the type and scope of the insurance plan. Revenue from all dental insurance providers including private health insurance, Medicare and Medicaid is included in this industry.
Companies within the industry largely compete on the basis of policy pricing.
Companies that can provide better pricing, including premium and member out-of-pocket costs, will remain competitive. The level and quality of service is also extremely important, since dental needs vary substantially on a client-to-client basis. Moreover, reputation and image are crucial for generating premiums, since perceptions about a provider's level of care often influence demand. Other factors that distinguish competing dental plans include the comprehensiveness of coverage and the financial stability of a provider. Smaller plan providers typically target a particular state or region, which may limit the scope of their coverage. Larger providers are frequently able to offer more extensive network coverage.
Products & Services Segmentation
Dental insurance plans differ in the level of reimbursement offered for certain procedures and in annual dental spending caps.
Plans can generally be divided into two categories: managed-care and fee-for-service. Managed-care dental plans are cost-containment systems that restrict the type, level and frequency of treatment, limit the access to care and control the level of reimbursement for services. Fee-for-service dental plans are generally arrangements where dentists are paid for each service performed according to the fees created by the dentist.
Dental plans can also be broken down into different categories for procedures. Preventative and diagnostic services generally include cleaning, oral exams and X-rays. Insurance plans typically cover 100.0% of these costs. For basic restorative services, including fillings and extractions, dental insurance usually covers 80.0% of the total cost. For major restorative services, such as bridges, crowns and complete dentures, dental insurance usually pays 50.0% of the total cost.
Statement sent to an insurance carrier that lists the treatment performed, the date of that treatment and an itemization of associated costs.
A specified amount of money that the insured must pay before an insurance company will pay a claim.
Insurance products where providers are reimbursed on a fee-for-service basis and there are no discounted provider contract agreements.
A noninsured program in which a panel of dentists agrees to provide services at a discounted price for enrollees.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is Medicaid's comprehensive child health program, which focuses on prevention, early diagnosis and treatment of medical conditions.
A healthcare organization composed of physicians, hospitals or other providers that offer healthcare services at a reduced fee. Payment is made when services are rendered.