South Carolina Insurance Practice Exam

In a scheduled dental policy, how are covered expenses paid?

1. Based on the dentist's billing

2. As a percentage of the total cost

3. Benefits are limited to a specific maximum dollar amount per procedure

4. Out-of-pocket maximum cost per visit

The correct answer is: Benefits are limited to a specific maximum dollar amount per procedure

In a scheduled dental policy, covered expenses are paid based on specific maximum dollar amounts assigned to each procedure. This means that the policy outlines the maximum benefit that will be paid for particular dental services, regardless of the provider's billing or the total cost of the procedure. It's important to understand that this type of policy typically lists various dental services and the corresponding benefit amount for each. For instance, a policy might state that a routine cleaning is covered up to a certain dollar amount, while a more complex procedure, like a root canal, would have a different specified limit. This structured approach allows policyholders to clearly understand their benefits and what they can expect to receive from their dental insurance for different types of treatment. Other payment structures, such as paying a percentage of the total cost or setting an out-of-pocket maximum per visit, do not apply in this context, as those methods differ from the scheduled approach of defining limits for each individual procedure.