Managed Care (DHMO or Dental HMO)
CapDent
The CapDent Plan is different from conventional dental programs with deductibles, maximums and other features that increase your out-of-pocket expenses. CapDent provides covered services through a network of participating dentists with no claim forms, lengthy predeterminations or waiting periods to cover pre-existing conditions.[Learn more]
CapDent Plus
Because affordability and choice are what members want in dental benefits, we put both into this enhanced dental plan. Sure to please purchasers as well as patients, the heart of this true point-of-service dental program is an affordable managed care plan using a network of participating dentists. Diagnostic and preventive services are covered in full, with minimal cost to patients for additional services. There are no deductibles, no maximums and no waiting periods for any treatment in-network. [Learn more]
CapDent Select
The CapDent Select Plan is different from conventional dental programs with deductibles, maximums and other features that increase your out-of-pocket expenses. CapDent Select provides covered services through a network of participating dentists with no claim forms, lengthy predeterminations or waiting periods to cover pre-existing conditions. For CapDent Select plans, members receive an increased benefit when seeing a participating specialist, with a referral. [Learn more]
CapDent Plus Select
Because affordability and choice are what members want in dental benefits, we put both into this enhanced dental plan. Sure to please purchasers as well as patients, the heart of this true point-of-service dental program is an affordable managed care plan using a network of participating dentists. Diagnostic and preventive services are covered in full, with minimal cost to patients for additional services. There are no deductibles, no maximums and no waiting periods for any treatment in-network. For CapDent Plus Select plans, enrollees receive an increased benefit when seeing a participating PPO specialist, with a referral. [Learn more]
Custom DHMO Plans
Based on the principle that it is less expensive to prevent dental disease than it is to treat dental disease. Managed Care Dental Plans or Dental HMOs offer comprehensive coverage at greatly reduced costs. Patients receive needed treatment and groups receive stable premiums - everyone benefits. Managed Care Plans include more coverage at lower costs. Many services are covered in full, including diagnostic and preventive treatment. Other services are covered with patients copayments that are a fraction of usual and customary dental fees.[Learn more]
Plan Comparison - Healthplex Managed Care Plans
| Healthplex Managed Care Plans | ||||||
|---|---|---|---|---|---|---|
| CapDent NY CapDent NJ |
CapDent Plus1 | CapDent Select | CapDent Plus Select1 | Custom DHMO Plan |
||
| Rates | ||||||
| Single | NY | 13.25 | $22.00 | $18.00 | $29.00 | Rates vary based on custom plan chosen |
| NJ | $12.80 | N/A | N/A | |||
| Two Party | NY | $22.00 | $38.00 | $31.00 | $52.00 | |
| NJ | $25.65 | N/A | N/A | |||
| Family | NY | $30.00 | $55.00 | $45.00 | $72.00 | |
| NJ | $36.65 | N/A | N/A | |||
| Type of Plan | In-Network Only | In/Out-of-Network Only | In-Network Only | In/Out-of-Network Only | In-Network Only | |
| Office Visit Fee | $0.00 | $5.00 | $0.00 | $5.00 | $0.00 | |
| Maximums | None5 | |||||
| Deductibles (waived for Diagnostic & Preventive) | None5 | |||||
| Waiting Periods2 | None5 | |||||
| Claim Forms | None5 | |||||
| Services | ||||||
| Type I: Diagnostic & Preventive | No Copays | No Copays | No Copays | No Copays | No Copays | |
| Type II: Basic | Copays Apply 3 | Copays Apply | Copays Apply 4 | Copays Apply 4 | Copayments vary based on custom plan chosen. Plans range from no Copays plans to plans with low Copays for these services. | |
| Type III: Major | Copays Apply 3 | Copays Apply | Copays Apply 4 | Copays Apply 4 | ||
| Type IV: Orthodontia | When services are rendered by a Capdent specialist, members receive a 25% discount off usual and customary fees. | $3350 Copay | $3350 Copay | |||
| Panel | CapDent Panel | CapDent Panel | General Dentist: CapDent Specialist: Healthplex PPO |
Dentcare Panel IHS Panel |
||
| Vision Benefit | Yes | Yes | Yes | Yes | No | |