Picking a dental benefit plan carrier for you and your family can feel overwhelming. Between the number of plan options and variations within each one individually it can be hard to feel confident even after you’ve done your due diligence and read about each plan thoroughly.
We think that understanding your dental benefit plan or choice to not be covered under a dental plan is invaluable and have compiled our most helpful tips, descriptions and definitions so you can pick (or keep) your next plan with confidence.
Understanding My Dental Plan
Using the term “insurance” for dental plans is not a truthful representation of what your plan actually is. It is not a payment to cover a loss, catastrophic event, or accident as your medical, auto or home insurance will. It is a benefit provided by employers to help employees cover the cost of dental care. Typically an employer will purchase a plan based on the amount of the benefit and cost of the premium for the company or employee. Think of your plan as a benefit plan that your employer contributes towards which will help to offset or subsidize the cost of your dental care.
How Dental Plans Work
Dental plans are a contract between your employer and insurance company. Your employer and insurer agree on the amount your plan pays and what procedures are covered. If you are not satisfied with your plans coverage or insurer experience, talk with your employer to let them know how it could be improved or changed.
Key Terms to Compare When Looking at Plans
Plan Year: What months does you plan year start and end? Most plans follow the calendar year (Jan-Dec) or have a benefit mid-year start/end (June-July).
Benefit year Maximum: What your annual maximum benefit dollar amount is for individual and family? Preventative and diagnostic treatments will count towards your maximum benefit for the plan year.
Waiting periods: Are there any waiting periods before you are able to use your benefits? If so, are those benefits something you had planned or needed to use right away? Do you have the ability to wait?
Age Limitations: Some plans have age limitations on service. This means that your insurance will only provide coverage up to or after a certain age.
Frequencies: How often does your plan cover specific treatments? It is important to look at what treatments you and your family use most or know that you have coming in the next year. Even if this insurance plan is new to you, companies share history and frequency, so limitations will still apply.
Percentage of coverage for:
Preventative/Diagnostic-including dental examinations, x-rays, cleanings and topical application of fluoride.
Basic Restorative– including fillings, routine extractions, root canals, periodontal treatments, & sealants.
Major Restorative and Prosthodontics-including Surgical extractions, crowns, bridges & implants.
Orthodontics-including braces or other appliances. Age limitations and lifetime benefit may apply.