Fee-for-service plans or Indemnity plans
Fee-for-service plans, also known as Indemnity plans, allow you to visit the dentist of your choice. The dentist does not have to be participating in a network.
When you receive treatment or care from a dentist, you will only pay a set percentage of the fee. The rest of the fee is paid to the dentist by the insurance plan.
What you pay:
The percentage you pay will vary depending on the type of treatment you are having:
Preventive treatment, such as cleaning, may be covered at 80%.
This would mean you only pay 20% of the fee.
Restorative treatment, such as a crown or bridge, may be covered at 50%.
This would mean you only pay 50% of the fee.
Fee-for-service plans usually require you to pay your part of the fee first (the ‘deductible’) before they pay the rest.
Sometimes, for preventive treatment, you won’t have to pay the deductible.
You can choose any dentist. They do not have to be part of a network.
Be aware that:
The fee-for-service dentist is not usually reimbursed the same amount as a PPO dentist, so you might have to pay a bit more for your dental care.
Your out-of-pocket expenses will generally be higher because the insurance company has not negotiated a fee schedule with the dentist.
Fee-for-service or Indemnity plans usually include a maximum amount of coverage per year.
Dentists are not required to go through the rigorous credentialing process as those who participate in PPO, EPO and DHMO networks are.
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