DHMO coverage

A DHMO coverage is a dental health maintenance organization plan that requires members to use in-network dentists for covered services. A DHMO covers preventive care, such as cleanings and exams, at no cost or with low copays.

A DHMO restricts access to specialists unless the primary dentist provides a referral, as seen in plans from DeltaCare USA and Cigna Dental Care. A DHMO excludes out-of-network benefits except for emergencies, which means patients pay full price outside the network, as detailed by Your Insurance Info.

A DHMO sets fixed copayments for procedures like fillings or extractions; for example, UnitedHealthcare’s Select Managed Care Plan lists $25–$50 copays per procedure. A DHMO requires members to select a primary care dentist upon enrollment, which guides all treatment decisions.

A DHMO usually has no annual maximum benefit limit–unlike PPOs–which eliminates yearly caps on covered costs. A DHMO enforces waiting periods only rarely; most plans activate immediately after enrollment according to MetLife TakeAlong Dental data.