Dental Insurance Plans offered by Sedona Benefits

Why Do You Need Dental Coverage?

The first-ever Surgeon General’s Report on Oral Health confirms that good oral health and your overall wellness are inseparable, calling the mouth “a mirror for general health and well-being.” Because it is so vital to the quality of your life, dental coverage should be an essential part of your health and wellness at any age. It helps you:

· Maintain good oral health throughout your life

· Enjoy the self-esteem that comes from looking your best

· Prevent oral diseases and craniofacial disorders

· Receive quality care

As with medical insurance, dental insurance two types are offered: Dental HMO and Dental PPO.

Dental HMO plans require you to use participating dentists and vary primarily in the amount they pay for restorative services. Typically you pay a small co-pay per office visit for exams, cleanings, and x-rays. There are no annual deductibles, no annual maximums, and no waiting periods for most services. They typically provide:

· Comprehensive benefits – a broad range of preventive, basic, and major services

· Specialty services – orthodontic and cosmetic

· Affordable monthly rates with minimal co-pay office visit fees for exams, cleanings, and X-rays

· Many other features including no hidden costs, no deductibles, no annual maximums, and no age limitations.

Dental PPO Plans allow you to see any dentist you choose. Using a PPO participating dentist saves you money because there’s no charge for preventive and diagnostic services and you’re assured that the dentist will charge no more than the carrier negotiated fees. Dental PPO plans often do not cover orthodontia and usually are subject to a calendar year deductible, an annual maximum benefit, and waiting periods where:

  • The Calendar Year Deductible is the amount you pay each year for covered services before the insurance company begins paying part of the cost. The deductible is often waived for preventive and diagnostic care but only at participating dental offices.

· The Calendar Year Maximum Benefit is the maximum dollar amount that the plan will pay per year for covered expenses. With a Dental PPO plan all dental benefits are limited to a maximum payment for expenses incurred by each enrolled member during a calendar year.

· The Waiting Period is the amount of time between the start of your membership in the plan and the date your coverage for certain benefits begins. There is no waiting period for preventive and diagnostic care. Coverage for basic care (e.g., fillings) may begin sooner than for major care (e.g., root canals).

The in-plan provider network is made up of a large number of dentists, specialists, and clinics that have agreed to provide services at negotiated rates to plan members. Although the Dental PPO Plan gives you the flexibility to visit any dentist you choose, it’s important to remember that when you choose a participating dentist within the plan network, you’ll save more money (see chart below).

At a participating dentist with negotiated rates

At a non-participating dentist

Total Charges



Carrier discount


Carrier negotiated fee


Carrier payment



You pay



Regular dental checkups and cleanings can help detect early signs of oral health problems, reducing the risk of permanent damage to teeth and gums and preventing costly treatments later. Also, a dentist may be the first to see signs of a health problem helping to keep it from becoming more serious.