Spirit Dental FAQ

Spirit Dental FAQ

How long will the enrollment process take?

Enrollment materials will be mailed to you within 7-10 days of a completed application.

How often do rates change?

Initial rates are guaranteed for 12 months and can change with 30 days notice after that.

What will I receive after enrollment?

An ID card and Policy Certificate of Coverage will be mailed to you.

I have more dependents than the form allows me to enter?

What does DHA-Premier PPO mean?

It is a network that provides dental care at discounted rates in return for expedited payment and assurance of a market share. Patients have a choice of using the Preferred Provider Organization panel of dentists or non-PPO provider, but there is a financial incentive to use the PPO.
What is an Indemnity Dental Insurance plan?

An indemnity dental insurance plan is often called a traditional dental coverage plan or a fee for service plan. In this type of dental insurance plan, you have the option to visit any dentist or dental care professional you wish. You do not need to select your dentist from a list of network providers or approved providers to qualify for benefits and coverage.

Features of an Indemnity Dental Insurance Plan

There are several features of indemnity dental insurance plans for individuals that make these plans different from many other types of dental coverage:

1. Insurance providers will pay up to 100% of preventive dental care. Typically, this includes regular checkups and cleanings. Many providers will also pay between 50% and 80% of regular and customary dental costs. These costs may include fillings, root canals, and other basic dental work. Check your policy to find out exactly what your plan does and does not cover.

2. Much of indemnity dental plan insurance benefits center around the term usual and customary. In general, only these treatments are covered by the dental insurance, and as can be expected, what providers consider to be ìusualî and ìcustomaryî varies widely. You will need to read the fine print of the policy your provider sends to find out what is and what is not covered.

3. There is often a maximum benefit amount for dental benefits with this type of coverage. If you require treatment beyond this limit, you will often be responsible yourself for these costs. It therefore makes sense to find a policy that has a high limit.

4. These dental insurance plans make use of a UCR (Usual and Customary and Reasonable) fee schedule. These schedules are tables that your dental coverage carrier uses to determine how much to pay you for specific services. These can dramatically affect how much reimbursement you get. For example, if your dentist charges higher fees for services than your dental coverage providers UCR fee schedule indicates is common, then your provider will give you less money for the procedure, leaving you to pay more for the bill.  Spirit Dental pays its UCR (usual and customary and reasonable) based upon the 90th percentile for the area in which you receive treatment.  For example, if 9 out of 10 dentists in your zipcode charged $100 cleaning and exam, Spirit would pay $100.  If the dentist charged $102, then Spirit would pay $100 and the dentist could balance bill you for $2.