D6. Dental Insurance

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  1. On an "integrated" medical and dental expense plan, which of the following statements is true about the deductible:
    A) It can be satisfied with either dental or medical expenses
    B) It is a different dollar amount on both plans
    C) It only applies for medical expenses
    D) It applies separately to both plans
    • A) It can be satisfied with either dental or medical expenses
    • Often medical and dental expense plan benefits are combined, or "integrated." On an "integrated" plan the deductible is generally the same and can be met with either dental or medical expenses.
  2. Dental insurance covers all of the following, EXCEPT:
    A) Gum cancer
    B) Root canals
    C) Fillings
    D) Decaying teeth
    • A) Gum cancer
    • Cancer of the gums, throat or mouth is covered by medical expense insurance, not dental.
  3. An individual is enrolled in a group dental expense policy, which pays claims based on what is usual, reasonable and customary. This means:
    A) The policy will pay benefits based on the average of what dentists usually charge for the services
    B) The policy benefits will vary depending on the cost of the services provided in various geographic locations
    C) The benefits will vary based on the usual amount of time spent on each procedure
    D) The policy benefits are listed as a flat dollar amount within the policy, as long as they are reasonable
    • B) The policy benefits will vary depending on the cost of the services provided in various geographic locations
    • Some medical expense and dental expense policies will pay benefits based on what is usual, customary and reasonable. Since medical and dental expenses vary from geographic location to location, the benefits will vary as well.
  4. All of the following are considered to be non-routine dental procedures, EXCEPT:
    A) Prosthodontics
    B) Annual check up
    C) Endodontics
    D) Orthodontics
    • B) Annual check up
    • Annual check-ups are covered as a routine dental procedure on dental expense insurance.
  5. Dental Expense policies generally have a deductible that would apply to all of the following services, EXCEPT:
    A) Orthodontics
    B) Preventative care
    C) Endodontics
    D) Prosthodontics
    • B) Preventative care
    • Dental Expense policies have deductibles that are very similar to Medical Expense plan deductibles. However, they generally do not apply to diagnostic or preventative care such as office visits, examinations and cleanings. If bridgework (prosthodontics), root canals (endodontics), and braces (orthodontics) are covered, they are subject to a deductible and co-insurance.
  6. Treatment for gum disease is known as:
    A) Orthodontics
    B) Endodontics
    C) Prosthodontics
    D) Periodontics
    • D) Periodontics
    • A "periodontist" is a dentist who specializes in the treatment of gum disease.
  7. An individual is covered under a group Dental Expense plan and needs to have some bridgework done. They are looking in their policy to see if it will be covered. Bridgework is also known as:
    A) Periodontics
    B) Endodontics
    C) Orthodontics
    D) Prosthodontics
    • D) Prosthodontics
    • You must know these definitions for your exam! Prosthodontics is bridgework, Periodontics is treatment of gum problems, Endodontics are root canals, and Orthodontics are braces.
  8. All of the following are true regarding "indemnity" plans of dental insurance, EXCEPT:
    A) They are also known as "reimbursement" plans
    B) Coverage may be written on a basic (scheduled) basis
    C) Care is provided by a pre-paid service plan, similar to an HMO
    D) Coverage may be written on a comprehensive (non-scheduled) basis
    • C) Care is provided by a pre-paid service plan, similar to an HMO
    • Indemnity plans, also known as "reimbursement" plans, are sold by dental insurance companies to provide coverage on a basic (or scheduled) basis, a comprehensive (or non-scheduled) basis, or both, which is known as a "combination" plan. However, dental services are also available from pre-paid dental service plans, which operate in a manner similar to HMOs.
  9. All of the following are true regarding dental insurance, EXCEPT:
    A) It is usually sold as individual coverage
    B) Coverage may apply on a usual, customary and reasonable basis
    C) There is usually no deductible on preventative care
    D) It covers "endodontics"
    • A) A) It is usually sold as individual coverage
    • Due to adverse selection, most dental insurance is sold on a group basis.
  10. In a dental plan, all of the following would be covered as a standard/basic service, EXCEPT:
    A) Orthodontic alignment
    B) Tooth extraction
    C) Crown replacement
    D) Emergency room
    • A) Orthodontic alignment
    • Orthodontic alignment, also known as "braces", is an optional coverage that is not included in a basic dental plan.
  11. All of the following are true regarding dental insurance, EXCEPT:
    A) It does not cover cosmetic dentistry
    B) Preventative care visits are usually limited to two during a 12-month period
    C) Fillings are usually limited to no more than three in a 12-month period
    D) A probationary period may apply to certain conditions
    • C) Fillings are usually limited to no more than three in a 12-month period
    • Although dental insurance is often subject to certain limitations, there is no limit on the number of teeth that need treatment.
  12. A specialized dental service that provides for treatment of missing teeth is known as:
    A) Prosthodontics
    B) Orthodontics
    C) Endodontics
    D) Periodontics
    • A) Prosthodontics
    • Bridgework (prosthodontics) is the dental specialty dealing with replacement of missing teeth and other oral structures.

Card Set Information

Author:
EdiesTeam
ID:
317804
Filename:
D6. Dental Insurance
Updated:
2016-03-22 20:44:24
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Dental Insurance
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Description:
Dental Insurance DISABILITY SECTION
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