The
best way to get the most out of your dental coverage is to understand its many
features. For instance, most insurance companies have various plans befitting
the needs and circumstances of different individuals. As well, dental benefits
are calculated within a benefit period, which is typically one year (though
possibly not a calendar year). There’s much to learn about dental coverage, so
here are a few aspects to help you get a better idea of it, especially if there
are any benefits left before the end of the year.
Maximums
Most
dental plans have an annual maximum, which is the dollar amount a dental plan
will pay toward the cost of dental care within a specific period, even if a
patient’s costs exceed the limit. The patient is personally responsible for
paying costs that exceed the annual maximum. A common annual maximum is $1000
or $1500 while some can go as high as $2000 or $3000. These totals can be individual
or family maximums.
Deductibles
Most
plans have a specific dollar deductible. The amount of dental expenses is the
responsibility of the beneficiary before a third party can assume liability for
payment of benefits. In other words, you personally have to pay a portion of
your bill before your benefit plan will contribute to your costs. Each plan
varies—for example, some apply the deductible to diagnostic or preventive
treatments while others do not. The deductible may be a one-time charge, or it
may vary depending on the program.
Coinsurance
Many
plans have a coinsurance provision, meaning the benefit plan pays a
predetermined percentage of the cost of your treatment. The part you pay is
called coinsurance—this is paid even after your deductible has been reached.
For example, you may pay 20 percent while your plan may cover 80 percent of the
expenses.
Reimbursement
Many
dental plans offer different classes of coverage. Each class provides a certain
percentage of coverage and certain limitations and exclusions. Each plan may
vary, so it’s best to go over your benefits carefully. For example, Class I may
offer coverage at the highest percentage—at least 80-100 percent of the plan’s
maximum allowance. Class II may cover only basic procedures like fillings,
extractions, and periodontal treatment, with reimbursements usually ranging
from 70-100 percent. Class III often reimburses at a lower percentage at 50
percent and may have a waiting period before services are covered.
Estimates
You
may want to ask your dentist to complete and submit a request for a cost
estimate. These are often referred to as pre-treatment estimates. This lets you
know in advance what procedures are covered though it is not a guarantee of
payment.
Exclusions
Exclusions
are dental services that aren’t covered by your plan. Some dental plans are
designed to help with expenses and may not cover every need, and these are
referred to as limitations or exclusions. Some health groups restrict coverage
for pre-existing dental conditions that are present before a patient enrolls in
a plan, such as a missing tooth.
Did
you know the Wellness Dental Plan can save you as much as 20 percent off your
dental bill? For more information about our family discount dental plans
,
please click here.
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