Traditional Plans

Traditional Plans, also sometimes called indemnity plans, pay the dentist on a traditional fee-for-service basis based on a “Usual, Customary and Reasonable” (UCR) schedule. A monthly premium is paid by the patient and/or the employer to an insurance carrier. The dental insurance company often reimburses the dentist directly for services provided based on a fixed percentage of the UCR fee. The UCR schedule is determined by the insurance carrier to be the “usual, customary, or reasonable” fees for the services in the community in which the services are delivered.

These plans often restrict the amounts and types of services covered. This includes, for example, lifetime limits on orthodontic treatment and in some cases, no coverage for more sophisticated services.

These plans typically have a co-payment feature which requires patients to pay for the difference between the dentist’s fees for fillings, crowns, bridges, dentures or braces and the amount paid by the insurance carrier.

Your MDS dentist wants you to know that:

• Traditional or Indemnity Benefits Plans allow patients to choose any dentist they want and will allow any dentist to provide your dental care, but often restrict what is covered.
• Many insurers have not updated or have been decreasing the “usual, reasonable, and customary” (UCR) fees they agree to pay dentists for particular procedures. In some cases, the UCR rates are lower than what is “usual” for a particular community and do not really reflect the dentist’s fee. Wide fluctuations in UCR fees between communities has made this payment system very problematic and unpredictable.