Dental Maintenance Organization (DMO): FSA Eligibility
What is dental maintenance organization (DMO)?
When taking a new job or shopping for new types of insurance, choosing the ideal dental plan is a major consideration that will cover the cost of regular dental checkups/cleanings, simple procedures like fillings and more advanced care options like crowns and bridgework. Typically, the most common options that individuals and families have to choose from is between dental maintenance organization (DMO) and a preferred provider organization (PPO) plans.
As opposed to a PPO plan where policyholders can visit any dentists that they like whether they are in-network or out-of-network providers, as well as including deductibles and annual maximums, DMOs are designed to be low-cost dental plans that feature no deductibles or annual maximums. However, under this arrangement, the policyholder chooses a primary care dentist, and if he/she needs to see a specialist, the dentist will provide a referral. DMO plans offer low monthly premiums, and the dentists who work with DMOs receive fixed fees each month, and the policyholder may need to make a copayment for certain types of procedures.
While there is less freedom in choosing dentists and other oral care specialists, DMO plans offer the unique benefit of excluding waiting periods, calendar year maximums, deductibles or claim forms. It is often the least costly dental plan available with the smallest monthly premiums (fees), nominal co-payments and a structured approach that can make it easy for policyholders to plan their expenditures and give them better control over their budgets (DentalInsurance.com).
Why aren't DMO premiums/fees reimbursed?
As a general rule, DMO premiums/fees cannot be reimbursed through a FSA. However, depending on how an individual's HSA or HRA are structured, these premiums may be reimbursable through their healthcare plans. Before choosing a dental insurance plan, it's advisable that prospective policyholders speak with their benefits administrator to inquire about dental maintenance organization fee reimbursement to help them plan out their future spending and make an informed choice with their dental plans.