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The Meat and Potatoes of Dental Insurance and What to Know

April 27, 2017

Most of our patients have policies through their employers or a family member with the remaining having some form of a medicare plan. For this article we will cover the common type of plan seen through an employer or family member’s employer.

There are hundreds to thousands of plan variations but most have a number of common clauses and coverage schedules. On average, a dental plan will cover the following classification of procedures at the listed percentages. Deductibles usually around $50 to $100 annually will also apply to some of these classes. Classifications are usually listed as A, B, and C, Major and Minor or further broken down in to procedure type like Endodontic, Prosthodontic, Restorative, Perio and Preventive. Below is an example breakdown:

 

Service Classification      Percentage Covered     Deductible

 

General Services             0                                    No

Crown                              50                                  Yes

Diagnostic                       100                                No

Endodontics                    80                                  Yes

Implant Services              50                                 Yes

Oral Surgery                    50                                  Yes

Orthodontics                   80                                  Yes

Periodontics                    80                                  Yes

Preventive                        100                                No

Prosthodontics                50                                   Yes

Restorative                      80                                   Yes

 

Annual Maximum $1000

 

Your annual maximum is the total number of dollars that your insurance provider will pay out towards dental services in a given policy year.

 

Waiting Periods: 6 months at start of coverage date. Applies to all services not listed under Diagnostic and Preventive.

 

A waiting period is sometimes applied to a dental insurance plan during the first 6 months to year of a policy holder’s coverage. This means that a certain list of services will not be covered until the waiting period is up. Most policies do not have a waiting period on cleanings and diagnostic procedures like x-rays and evaluations.

 

If your policy is covered through an employer you might not have much choice in what the policy details will entail. This is generally determined between your company and the insurance provider. However, you can choose whether the plan is right for you and how it might help with receiving dental care.  If you have any questions regarding your coverage. Call our office to speak with our insurance coordinator. We are happy to explore your policy for you.

 

 

 

 

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