Usual, Customary and Reasonable

There is no regularion as to how insurance companies determine reimbursement levels in a dental insurance policy.  This can result in very wide fluctuations.  "Usual, Customary and Reasonable" (UCR) may be one of the most misunderstood terms used in describing dental insurance.  UCR plans may pay an established percentage of the dentist's fee, or what the dental plan considers a "customary" or "reasonable" fee limit, whichever is less.  Although these limits are called "customary", they may or may not reflect the actual fees that dentists in your area charge.

Since our dental plans are not insurance, discount dental plan members pay a membership fee which allows them to pay discounted rates at participating dental providers, at the time services are rendered.

Annual Maximum

Most dental insurance plans place an annual cap on the amount of reimbursement, usually $1,000 to $1,500 per year.  The insured under the dental insurance plan is responsible for all costs incurred after that, in the same year.

Since our dental plans are not insurance, discount dental plans have no annual maximum.  You can use your dental plan as often as you need to.

Least Expensive Alternative Treatment Provision

Some dental insurance plans will only pay for the least expensive treatment in a particular situation.  For example,  your dentist may recommend a crown on your tooth, but the dental insurance policy will only provide reimbursement for a filling.

Since our dental plans are not insurance, discount dental plans contain no "Least Expensive Treatment" provision.  You select the treatment that is right for you not an insurance company.

Pre-Existing Conditions

Just as with health insurance, the dental plan may not cover conditions an individual had before enrolling in the group dental plan or the individual dental insurance policy.  Other dental plans will place long waiting periods, anywhere from 6 to 18 months, before paying for major dental treatment.

Since, discount dental plans are not insurance, ongoing dental problems are covered immediately, with only minor exceptions.

Deductibles

This is an amount that you will pay first, before the dental insurance company will start any reimbursement.  The deductible may range from $50 - $100, or more.  This deductible normally must be satisfied before any treatment, even preventative treatment, will be reimbursed.

Since, discount dental plans are not insurance, dental plans provide instant savings with no waiting periods and no deductibles.