Insurance World

At first glance, an indemnity health insurance plan may seem to hand policy holders the short end of the stick. After all, this type of insurance tends to pay less toward health care claims than a managed-care plan. Additionally, the policy holder generally pays more out-of-pocket and has to deal with more paperwork when it comes time to file a claim.

However, for a great number of people, indemnity is the undeniable way to go. Individuals may choose indemnity plans because they have favored health care providers who are not part of a managed-care network, or because they travel a lot and need the flexibility to seek care away from home, or for any number of other reasons. What makes an indemnity plan the right choice is different from one consumer to the next.

What primarily separates an indemnity plan from a managed-care plan is the presence or absence of a provider network. A managed-care plan comes with a network of health care providers who have arranged with the insurance company to provide their services at an agreed-upon rate. This allows the insurance company to know how much to expect to pay for any given service. It also allows the provider to know to some extent which services will be covered and the corresponding level of coverage. Because the insurance company has made prior arrangements with these providers, paperwork can be filed directly between the provider and the insurance company. The insurance company pays the provider directly for care, requiring the policy holder to pay only a small percentage of coinsurance or minimal co-pay amount out-of-pocket.

With an indemnity plan, on the other hand, there is no network of pre-approved providers. This means the insurance company is taking a greater risk when it comes to a policy holder’s choices of health care providers. The policy holder may choose a provider that charges more than the insurance company expected to pay for a particular service.

For this and other reasons, insurance companies offering indemnity plans give themselves some protection from the choices their policy holders may make. They typically charge a higher annual deductible that must be met before coverage begins. They often require policy holders to pay the full cost for the service out-of-pocket and then to file the paperwork of the claim themselves to seek reimbursement for the care. This protects the insurance company from paying for services that are not covered under their plans and also from paying more than what is reasonable for the care their policy holders are claiming. The insurance company may determine a reasonable charge for a service by referring to a table of UCR (usual, customary, and reasonable) figures determined by the average cost billed by providers in a particular area.

An indemnity plan may sound like a poor choice for a consumer to make, but for the reasons mentioned earlier as well as others, an indemnity plan can be the best choice for some consumers. An indemnity plan does not require its policy holders to choose a primary care physician (PCP) or obtain a referral to receive care. In this way, it’s one of the easiest plans to use. Policy holders seek their health care whenever and from whomever they choose.

Deciding between an indemnity and a managed-care plan is an individual choice. Like all decisions pertaining to health care and health insurance, the options should be thoroughly researched and carefully considered. Under the right circumstances, an indemnity plan can offer the greatest flexibility in obtaining health care and provide its policy holders the opportunity to be in maximum control of their health care choices.

Delta Dental Plans Association, more commonly known as Delta Dental, is one of the best known dental insurers in the United States. Delta is a not-for-profit association that offers dental plans of all types for companies across the U.S. Their 39 member companies administer dental benefit plans whose main focus is providing and improving access to dental care for all. Today, Delta Dental associates provide dental coverage to over 46 million people through over 80,000 employers and agencies.

Delta Dental insurance offers three major plan types to suit a wide range of needs. The benefits vary by plan, and costs vary by region and employer.

Delta Dental Premier (formerly DeltaPremierUSA)
Delta Dental Premier is a traditional fee-for-service insurance plan. If you have Delta Dental Premier, you can visit the dentist of your choice within or outside their provider network. The dentist bills Delta Dental directly, and Delta Dental pays their portion of the bill (most often a set dollar amount), then sends you an explanation of your portion of the bill, which you pay to the dentist.

Ex. Delta Dental pays $45 for a filling. Your dentist charges $60 for a filling. You pay the dentist $15.

Delta Dental PPO (Preferred Provider Option)
Like the Premier plan, Delta Dental PPO pays a fee for each service. You may also visit any dentist that you choose, but will pay lower fees to dentists who are part of Delta’s Preferred Provider network. The dentist handles all the paperwork and claim forms. Delta generally pays a percentage of the procedure rather than a set dollar amount.

Ex. Delta Dental pays 70% of the fee for an extraction. Your dentist charges $210 for an extraction. You pay the dentist $63.

DeltaCare HMO
DeltaCare focuses on prevention and maintenance of your dental health. When you enroll in DeltaCare, you choose a primary care dentist who will be responsible for your dental care. If you require specialty services – orthodontics or oral surgery, for example – your primary care dentist must refer you for services. You pay a low or no co-payment for any dental services provided.

Ex. Depending on the plan, you may pay a $10 co-payment for office visits, no matter what the procedure.

The cost and availability of each option is dependent on the company through which you enroll. As the nation’s largest provider of dental insurance, the costs are significantly lower than most other plans.