1. Annual Maximum Carryover (PPO Elite Plans)
Dentist DIRECT Dental Plans allow our members to carryover a portion of their annual maximum as they obtain 1 oral exam each year and stay below the threshold.
- $1,000 Annual Max (Year 1)
- $500 Threshold (50% of Annual Max)
- $250 Carryover (50% of Threshold)
- $1,250 Annual Max (Year 2)
- Carryover Max (Up to $2,000)
2.) Dental Implant Coverage (PPO Elite Plans)
Dentist DIRECT Dental Plans include coverage for Dental Implants, allowing our members to choose the treatment that is best for them (paid same as 3 unit bridge).
3.) Cleanings & Exams
All PPO Elite plans include 2 Cleanings & Exams per year, providing our members the freedom to use them anytime they want (“1 every 6 months” is not the same). PPO Essentials plans offer lower premiums by including cleanings and exams 1 every 6 months.
4.) Specialist Coverage
All Dentist DIRECT Dental Plans (both PPO Elite and PPO Essentials) pay Specialists as Specialists. Other carriers may pay Specialists the “same as a General Dentist.” Even though it may not show up on a spreadsheet comparison, these two phrases are very different when it comes to your dental care.
Specialists have received years of additional training, have customized instruments, and a more defined scope of practice. They are typically solving more complex issues that are not addressed by a Generalist. Just like in the medical world, this allows them to charge a higher fee. If your carrier pays a Specialist the same as a General Dentist, that can leave you responsible to pay the difference between the General Dentist fee and the Specialist fee – even if you are seeing an in-network Specialist.
Here’s an example of what that means for you.
*Best case scenario assuming the Specialist accepts $400 as payment in full.
**Without a Specialist Fee Schedule limiting the amount a Specialist can charge, the member is exposed to balance billing (i.e. $400+).
Avoid unexpected expenses by choosing a carrier that pays Specialists as Specialists.