How are covered expenses typically paid under a scheduled dental policy?

How are covered expenses typically paid under a scheduled dental policy?

• A. A coinsurance is normally applied to benefits paid
• B. A deductible must be met by the insured before benefits are paid
• C. Benefits are limited to a specific maximum dollar amount per procedure
• D. Covered expenses are fully reimbursed to the insured

Answer: (C)

In a scheduled dental policy, benefits are structured in a way that sets specific limits on the amount reimbursed for each type of dental service. This means that for each procedure covered under the policy, there is a predetermined maximum dollar amount that the insurer will pay. For instance, if a dental procedure costs more than the scheduled amount, the insured is responsible for covering the difference. This allows the insurer to manage costs effectively while providing a clear framework for what patients can expect to be reimbursed. This approach contrasts with other types of payment structures such as coinsurance or deductibles, which might apply under different types of health insurance policies. Here, there are no coinsurance percentages taken off the benefits, nor do patients have to first meet a deductible before receiving benefits under the scheduled approach. Coverage is straightforward and limited, guiding patients about the amount they can expect for various dental services.

In a scheduled dental policy, benefits are structured in a way that sets specific limits on the amount reimbursed for each type of dental service. This means that for each procedure covered under the policy, there is a predetermined maximum dollar amount that the insurer will pay. For instance, if a dental procedure costs more than the scheduled amount, the insured is responsible for covering the difference. This allows the insurer to manage costs effectively while providing a clear framework for what patients can expect to be reimbursed.

This approach contrasts with other types of payment structures such as coinsurance or deductibles, which might apply under different types of health insurance policies. Here, there are no coinsurance percentages taken off the benefits, nor do patients have to first meet a deductible before receiving benefits under the scheduled approach. Coverage is straightforward and limited, guiding patients about the amount they can expect for various dental services.