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Getting a handle on your dental insurance is step #1 to guarantee you get the maximum benefit from your dental coverage.We realize that some of the “fine print” and lots of the dental insurance language can be somewhat confusing, so we prepared the following guidelines to take the mystery out of your dental plan.
To help you better understand these fundamentals of your dental coverage, here's a brief explanation of each one:
Essentially, a benefit period is the length of time during which the benefit is paid. Your dental coverage has both a plan “effective date” and an “end date,” and in most cases, the benefit period for your plan will be one year.
So, if your effective date on your plan is January 1, 2019, and the end date is December 31, 2019, you will no longer have coverage as of December 31, 2019, unless you renew your plan before the end date.
These two terms may sound similar, but they are not exactly the same. Both are fees that the patient is responsible to pay for a portion of their dental treatments.
Similar to your home owner or auto insurance policies, the dental plan deductible is simply the amount that you must pay out of pocket, before the insurance policy pays for any treatments. Most dental plans do have annual deductibles, some are for each individual covered on the plan and some will be 1 deductible for all family members included in the plan.
Some plans do not have a deductible required for some of the basic preventative treatments and services such as annual check-ups, cleanings, x-rays, etc.
Review your specific dental plan coverage to determine what deductibles you are responsible for.
Your dental plan probably mentions two types of maximums: annual and lifetime.
Dental insurance plans generally cover different treatments and services at different percentages (a.k.a reimbursement levels). The various types of services are categorized into 3 main classes with different reimbursement levels for each class. There are also some exclusions or restrictions noted for each class as well.
Here are the 3 main classes, and the reimbursement levels that generally apply to each class*:
In some cases, a plan will require a waiting period prior to allowing coverage for a specific treatment. For example, suppose your plan has a 4 month waiting period for root canals. If your plan coverage began on January 1, then your waiting period ends on May 1. Anytime after May 1, you are eligible to use your benefits for this treatment.