Dental health benefit plans vary widely. You should know how your dental plan is designed, since this can significantly affect the dental plan's coverage and your out-of-pocket expense. Although the individual features of dental plans may differ, the most common can be grouped into the following categories:

Direct reimbursement dental insurance plans reimburse patients a predetermined percentage of the total dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed, allows patients to go to the dentist of their choice, and provides incentive for the patient to work with the dentist towards healthy and economically sound solutions.

Usual, Customary and Reasonable" (UCR) dental insurance plans usually allow patients to go to the dentist of their choice. These plans pay a set percentage of the dentist's fee or the plan administrator's "reasonable" or "customary" fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called "customary," they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of regulation on how a dental plan determines the "customary" fee level..

• Table or Schedule of Allowance dental insurance plans determine a list of covered services with an assigned dollar amount. That dollar amount represents just how much the plan will pay for those services that are covered, regardless of the fee charged by the dentist. The difference between the allowed charge and the dentist's fee is billed to the patient.

• Capitation dental insurance plans pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge (for some treatments there may be a patient copayment). The capitation premium that is paid may differ greatly from the amount the plan provides for the patient's actual dental care.

To help contain costs, your dental insurance plan may limit your benefits by number of procedures and/or dollar amount in a given year. In most cases, particularly if you've been getting regular preventive care, these limitations allow for adequate coverage. By knowing in advance what and how much your plan allows, you and your dentist can plan treatment that will minimize your out-of-pocket expenses while maximizing compensation offered by your benefits plan.

Peer Review for Dispute Resolution Many plans provide a peer review mechanism through which disputes between third parties, patients and dentists can be resolved, eliminating many costly court cases. Peer review is established to ensure fairness, individual case consideration and a thorough examination of records, treatment procedures and results. Most disputes can be resolved satisfactorily for all parties. Key Features to Consider When Selecting a Dental Plan In reviewing and comparing dental plans, consider the following when determining whether the coverage will satisfy your dental care needs:

• Does the plan give you the freedom to choose your own dentist or are you restricted to a panel of dentists selected by the dental insurance company? If restricted to a panel, is your dentist on this panel?

• Who controls treatment decisions – you and your dentist or the dental plan? Some plans may require dentists to follow the "least expensive alternative treatment approach."Does the plan cover diagnostic, preventive and emergency services? If so, to what extent?

• What routine treatment is covered by the dental plan? What share of the cost will be yours?
What major dental care is covered by the dental plan? What percentage of these costs will you be required to pay?

• What are the plan's limitations (a limit to the benefits for a procedure or the number of times a procedure will be covered) and exclusions (denied coverage for certain procedures)?

• Will the plan allow referrals to dental specialists? Will my dentist and I be able to choose the specialist?

• Can you see the dentist when you need to and schedule appointment times convenient for you?

• Who is eligible for coverage under the plan and when does coverage go into effect?