FUTURE OFDENTISTRY
out dental prepayment, the entire billing for dental
services is paid by the patient or some designated
person, usually a relative. For individuals with den-
tal prepayment, this refers to the portion the billing
for dental services not covered by the plan and is
paid by the patient, or some designated person.
These payments may be for noncovered services or
as copayments for covered services. Types of copay-
ments include: deductibles, copayments, and ex-
penses above the maximum allowed by the plan.
Coinsurance:
A provision of a dental benefit program by which
the beneficiary shares in the cost of covered servic-
es, generally on a percentage basis. The percentage
of a covered dental expense that a beneficiary must
pay (after the deductible is paid). A typical coinsur-
ance arrangement is one in which the third party
pays 80% of the allowed benefit of the covered den-
tal service and the beneficiary pays the remainder of
the charged fee. Percentages vary and may apply to
table of allowance plans; usual, customary, and rea-
sonable plans; and direct reimbursement programs.
Deductible:
The amount of dental expense for which the ben-
eficiary is responsible before a third party will
assume any liability for payment of benefits.
Deductible may be an annual or one-time charge,
and may vary in amount from program to program.
Maximum Benefit:
The maximum dollar amount a program will pay
toward the cost of dental care incurred by an individual
or family in a specified period, usually a calendar year.
Premium:
The amount charged by a dental benefit organi-
zation for coverage of a level of benefits for a spec-
ified time.
Referral Plan:
This is a type of plan that refers employees or
members of a group, such as a professional associa-
tion, to a group of participating dentists who will
provide dental services at a discount from their
usual fees to individuals enrolled in the plan. The
referral service may be provided free to employees
or group members, or a membership fee may be
charged. No insurance or third parties are involved.
Financial arrangements are directly between the
participating dentist and the member of the plan.ReferencesAmerican Dental Association, Survey Center. 1997 Survey of
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