Insurance Glossary

A DHMO (Dental Health Maintenance Organization) is a type of dental plan where members select an in-network primary dentist from which they must receive care. Often, this dentist must authorize referrals to specialists such as endodontists, periodontists, pediatric dentists, or oral surgeons. Out-of-network benefits are generally limited to emergency care only.

Most indemnity and PPO dental plans require you to pay a fixed amount before the dental plan benefits are paid. This fixed amount is called a deductible and it exists to encourage members to take greater responsibility for their healthcare. Dental plans often do not require a deductible for preventive and diagnostic services (Class/Unit I or Type A). This is designed to encourage regular dental visits. Deductibles for Class/Unit II (Type B) and Class/Unit III (Type C) services vary by dental plan. Often, there is a deductible for each covered family member. In some cases, one family deductible applies to all covered family members. Your dental plan documents will clearly outline the dental plan deductibles and the services to which the deductible applies. Deductibles reset at the beginning of each plan year.

Individuals covered under the primary member's dental plan are considered covered dependents. Dependent eligibility is defined by the dental plan sponsor or dental plan administrator and must comply with various federal and state laws. Eligible dependents include a spouse, and children up to the age of 26 (married or unmarried). It may also include children or other family members with special needs or circumstances.