Can cover employees and their dependents for preventative, restorative and major services performed at a Dentist's office depending on the provider and the type of coverage being offered. It is important to recognize the difference in most Dental plans before making a decision on which type of coverage best fit you and your family.
DMO Plans: - Requires that an employee select a primary care dentist to coordinate their care from the available managed dental network. Each family member may choose a different primary care dentist and can usually switch dentists at any time. If specialty care is needed, a member's primary care dentist will refer them to a participating specialty dentist. These plans are usually not subject to annual maximums or deductibles however the employee will have to follow a schedule dictating the co-pay for a specific service. It is important to note that an employee must stay within the provider network for services to be covered.
PPO Plans: - These plans give their member a choice to use a dentist who participates in the network or choose a licensed dentist of their own that does not participate. Although these plans give a member the freedom to choose any dentist they want, most plans are subject to waiting periods, deductibles and annual maximums. Typically the benefits received while seeing a non-participating dentist is less then if you see one that does participate in the carrier’s network.
Cost Sharing Plans: - Many carriers offer plans with substantially lower premiums which have higher deductibles for services you utilize least, such as Inpatient Hospitalization. These plans give you the best of the traditional HMO/PPO plans combined with Major Medical Plans.
Madison Avenue Brokerage Corp. will serve as your advocate in dealing with the various carriers and their representatives.