More than half of American adults have gum disease, while nearly 30 percent have untreated cavities. Despite the known potential risks of not treating these and other dental conditions, many of these people cannot pursue the treatment they need due to the costs involved with dental care. Fortunately, dental insurance can often make expensive treatments significantly more affordable.
The key to making this happen, though, is understanding your dental insurance policy’s key elements. This task is made easier by becoming familiar with the terms involved in your plan. Be it diagnostic, preventive, or restorative treatment. It helps to know the meanings of the terms used in your policy.
Supreme Dentistry is a high-end dental practice intent on explaining the ins and outs of the care you need, as well as the nuances of your dental insurance policy. We understand that the physical and financial costs involved in undergoing necessary dental work can be taxing, so we aim to make the entire process as carefree and simple as possible. Reach out today to learn more about how Supreme Dentistry can help you with all of your dental care needs by calling 844.966.2333
Why Understanding Key Dental Insurance Terms Is Important
The terms used in most dental insurance policies
are typically organized into one of three categories: costs associated with out-of-pocket items, general limitations on the services that are insured, and specific services that are excluded from coverage. Knowing the meanings of these key terms will enable you to grasp fully:
- The costs of each procedure
- The limitations you’ll encounter as you seek treatment
- Any exclusions contained within your dental insurance policy
- The big picture associated with you pursuing dental treatment
Key Dental Insurance Terms You Need to Know
While there are literally hundreds of terms (some complicated, some not) involved in most dental insurance policies, these are among the most relevant and frequently used:
- Annual Maximum: The total dollar amount a dental insurance plan will pay for you (the member) or your family member in a given period. It’s typically for one full calendar year.
- Benefit Year: The 12 months covered by your dental plan.
- Claim: Dentists submit this information to the dental plan to get paid for services they’ve performed for you.
- Coinsurance: The percentage of the costs of services paid by you.
- Copayment: Your share of payment for a given service.
- Covered Service: A dental treatment for which payment is provided under the terms of your dental plan.
- Deductible: Your out-of-pocket costs, or the dollar amount you must pay before benefits are paid.
- Dependents: Any child or spouse that is covered by your dental plan.
Take a moment to familiarize yourself with these terms and, if you are able, look over your own insurance information. Some other terms to learn include:
- Effective Date: The date on which your dental coverage begins.
- Exclusions: Services that you must pay for because a dental plan does not cover them.
- Explanation of Benefits (EOB): A paper or electronic document details the dental treatments and services paid for on your behalf. It is different from a bill.
- Group: A company or organization that provides dental plans to its employees. The group selects the benefit levels, plan type, and member eligibility.
- In-Network Dentist: A dentist who has agreed to be a part of a network.
- Limitations: Services that you must pay for because they are limited from a dental benefit plan.
- Lifetime Maximum: The maximum amount a plan will pay over the course of a lifetime.
- Member: An individual who has signed up for dental coverage.
- Network: Consists of participating dentists who provide dental treatment within agreed-upon fees.
- Open Enrollment: The period of the year during which qualified individuals can enroll in or adjust their benefits plan.
- Out-of-Network Dentist: A dentist who has not signed up to participate within a particular network.
- Premium: The amount you as the member pays for dental benefits.
- Preferred Provider Organization (PPO): This health plan contracts with dentists to create a network of participating providers. Using providers from this network allows you to pay less.
- Termination Date: The specific date your dental coverage ends or when you’re no longer eligible for benefits.
What Exactly is Considered Basic Dental Care?
It’s also important to know the difference between basic dental care services and major dental care services. Basic dental care includes:
- Emergency care for pain relief
- Sedative fillings
The typical dental insurance plan covers 80 percent of these services. It also covers all preventive procedures, including routine cleanings and exams.
Because they’re more elaborate, treatments such as bridges, crowns, and dentures are considered major dental care. As a result, these procedures typically receive no more than 50 percent coverage from the typical dental insurance plan.
Let Supreme Dentistry Make Your Dental Health Simple
Your dental health is an important part of your everyday life. While dental insurance can be complicated, it should never prevent you from pursuing the dental care you need and deserve. Our caring and highly skilled staff at Supreme Dentistry intend to explain to you the intricacies of your specific dental insurance plan.
If you require dental work, we provide the basic and major dental care services you need. From general checkups to cosmetic procedures (including implants, Invisalign, and whitening), we use the most advanced technology to ensure you’re calm, confident, and comfortable before and after your dental procedure.
To learn more about how you can get the most out of your dental insurance plan, reach out to us using our online form or call 844.966.2333