Healthy Smiles vs. Insurance

Benefits HSD Plan Dental PPO Plans1 Dental HMO Plans2
All Provided dental treatments and procedures 100% paid by patient after reaching max annual allowance Only procedures listed on the patient charge schedule are covered
Waiting Period NONE 6 months - 2 years NONE
Annual maximum allowance UNLIMITED $1,000-$1,500 NONE
Annual deductible NONE $50 per individual NONE
Exclusions for pre-existing conditions NONE YES YES
Exclusions on coverage NONE YES YES
Limitations on treatment NONE YES YES
Age Limitations NONE YES YES
Replacement Limitations As Warranted YES YES
Prior Authorization NONE YES YES
Claim forms NONE YES YES
Prophylactic Coverage
Periodic exams As needed 2 per year 2 per year
Bitewing x-rays As needed 2 per year 2 per year
Full-mouth x-rays As needed Once every 3 years Varies per plan
Panoramic x-rays As needed Once every 5 years Varies per plan
Hygiene Therapy
Basic (prophylactic cleaning) Every 6 months 2 per year 2 per year
Perio maintenance As recommended 3 per year Limited
Full-mouth debridement As recommended Once every 3-5 years Varies per plan

1 This is an average range of values and limitations of major dental PPO insurance plans. Each individual insurance plan may have some of the illustrated parameters on the terms of negotiation contract.

2 This is an average range of values and limitations of major dental HMO insurance plans. Each individual insurance plan may have some of the illustrated parameters on the terms of negotiation contract.

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