A traditional dental insurance or self-insured plan allows the covered person to select any dentist (freedom-of-choice), with the plan paying all or a portion of the dentist’s usual treatment fee.

Payment for services can be made directly to the dentist or may be assigned to an insurance carrier to pay the dentist if that is office policy. If full payment for the dental service is made to the dentist, the office staff should be able to assist in completing a claim form for submission to the plan administrator for reimbursement. If the dentist accepts assignment, then any portion of treatment services not reimbursed by the plan will be balanced billed to the covered individual as part of a co-insurance payment.

Reimbursement under these types of plans is usually based on a percentage of the average dental fees in the geographic area where the dentist practices.

Depending on the plan design, the covered individual may have to meet a yearly deductible prior to the insurance policy covering any dental services. These plans usually have annual maximums between $1,000 and $1,500. Traditional dental insurance/self-insurance is usually part of a group dental plan sponsored by an employer.