Co-Insurance

Co-insurance refers to the percentage the insurance company or administrator and the patient are responsible for. The co-insurance generally applies after the deductible has been met and only applies to covered expenses.

The examples on this page are for education only. Please refer to your dental plan summary for specific information.

Following is a typical breakdown for co-insurance payments.



The impact of co-insurance on a standard claim is illustrated in this example:



Co-insurance applies differently to Preferred Provider Organization (PPO) and non-PPO claims.

- The co-insurance for a PPO dentist is based on the discounted fee. In the example below, the co-insurance is applied after the PPO dentist's discount.
- The co-insurance for a non-PPO dentist is based on the lesser of the dentist's fee or the usual, customary and reasonable fee. Non-PPO dentists do not discount their fees.

In this example, you can see the impact of co-insurance on a PPO claim:



Visiting a PPO dentist typically results in lower out-of-pocket expenses. As shown in the example, the patient saved $90 by using a PPO dentist. Please refer to your dental plan summary for specific information about your benefits.