With a scheduled dental policy, how are covered expenses paid?
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
The Correct Answer and Explanation is :
The correct answer is b. A deductible must be met by the insured before benefits are paid.
Explanation:
A scheduled dental policy, often referred to as a “fixed-benefit” plan, works by providing a predetermined benefit for specific dental services outlined in the policy. Under this type of policy, covered expenses are subject to a deductible that the insured must pay out-of-pocket before the insurance company starts to pay for services.
Here’s how each option works in relation to a scheduled dental policy:
- a. A coinsurance is normally applied to benefits paid
- While some dental plans include coinsurance, scheduled dental plans typically don’t focus on coinsurance. Instead, the insurer pays a set amount for each procedure. The insured might have to cover some of the costs if the procedure exceeds the scheduled benefit.
- b. A deductible must be met by the insured before benefits are paid
- In scheduled dental policies, a deductible is often a requirement before the insurer covers any expenses. This means the insured must pay a certain amount out-of-pocket for dental services before the policy begins to contribute to the costs.
- c. Benefits are limited to a specific maximum dollar amount per procedure
- Scheduled dental plans typically limit the amount the insurance will pay for each specific dental procedure (such as cleanings, fillings, or extractions). However, this is not the same as a deductible, which must be paid before any benefits are paid out.
- d. Covered expenses are fully reimbursed to the insured
- This is not typical of scheduled dental plans. These plans usually provide only partial reimbursement, and the amount paid depends on the specific procedure and its corresponding scheduled benefit. The insured will often need to cover the remainder of the cost.
In summary, a deductible must usually be paid by the insured before the insurance company contributes to the cost of dental care in a scheduled dental plan. After the deductible is met, the insurer will pay a fixed amount per service, often with limits on what it will cover for each procedure.