AD Banker Comprehensive Practice Exam

What type of dental policy limits benefits to specified maximums per procedure with first dollar coverage?

1. Non-scheduled

2. Reimbursement

3. Scheduled

4. Blanket

The correct answer is: Blanket

The type of dental policy that limits benefits to specified maximums per procedure while offering first dollar coverage is known as a non-scheduled policy. This type typically pays for dental procedures without requiring a deductible or waiting for a certain amount to be reached before coverage kicks in, hence the term "first dollar coverage." It sets a fixed amount that the insurance will cover for each procedure, allowing the policyholder to understand clearly what their benefits will be for specific services. In contrast, a scheduled policy provides a list of covered procedures along with the maximum benefit for each, which usually means costs may vary significantly from one procedure to another. This arrangement reflects the structured approach of scheduled policies, making it easier for policyholders to know precisely what benefits they can expect for each dental service. Reimbursement policies generally involve the insured paying the dentist and then getting reimbursed by the insurance company, rather than promising coverage upfront. Blanket policies cover a wide range of services but typically do not specify the maximum per procedure as clearly as scheduled policies do. Thus, the correct understanding revolves around the characteristics of various policies in dental insurance, emphasizing how first-dollar coverage and maximum limits are structured within non-scheduled plans.