Common Terms Dental Insurance Explained

Posted on November 4, 2014 in Insurance

Preventive care is what we do to keep our bodies healthy. Preventive dental care also helps us maintain the health of our mouths as we work to avoid tooth decay, tooth loss, and other harmful issues.

Biannual dental visits are encouraged because they help prevent problems in the mouth from occurring. When your dentist catches cavities and decay early on, they can stop them from getting worse. This reduces your chance of needing complex dental work down the road. It also helps your dentist see any changes in your mouth when you return six months later for your next appointment!

Did you know your dental benefits are based around preventive care? When you understand what preventive care is, you can better understand how to put your dental benefits to use. 

Better understand your dental benefits by getting familiar with how they work:

How Preventive Care Works with Your Dental Coverage

Because we believe in the importance of dental care, Delta Dental plans usually cover 100 percent of routine preventive and diagnostic care. This includes dental care procedures like cleanings, exams, and x-rays.

If your dentist comes across tooth decay or signs of a cavity, fillings, root canals, and tooth extractions are usually covered up to 80 percent. That means Delta Dental will pay the majority of the cost, leaving you with 20 percent to pay.

*Be aware that a deductible — the amount you pay before your dental insurance kicks in — may apply to these services. Your coverage will depend on your specific plan design.

What is a Dental Claim?

A dental claim is created when you get a dental procedure done. It's a document that outlines the procedures that were performed while you were at the dentist. This document is sent to your insurance provider, Delta Dental. Our team members review the claim against your oral health history and ensure your benefits are applied correctly to the procedures.

What is a Deductible?

The amount of money a member agrees to pay before Delta Dental starts to pick up the tab is called your “deductible.” You must pay for your dental care until your plan’s deductible is met. However, you only have to meet your deductible once in a plan year.

Deductibles usually do not  apply to regular exams, x-rays, and cleanings. Plus preventive care services like cleanings are usually covered as soon as your plan starts. So there really is no excuse not to go to the dentist for these routine visits.

Sign into our Member Connection to review your deductible.

What is a Copay? What is Coinsurance?

Coinsurance and copays are how you share the cost of dental procedures after you’ve met your deductible. A copay is a fixed dollar amount, like $20. Coinsurance, on the other hand, is usually written as a percentage. 

With a copay, you’ll always pay the fixed amount (say, $20) no matter how much the total cost of your appointment was. As a percent, coinsurance changes depending on the total cost from the dentist. When you see an in-network dentist, you most likely will have better coverage for services and lower out-of-pocket costs. Delta Dental dentists cannot bill more than the allowed network fee for covered services.

What is a Dental Plan’s Annual Maximum?

This refers to the maximum amount of money your plan will pay for dental services in your plan year. If your plan is based on the calendar year, then the time frame for your annual maximum is from January to December.

If you reach your annual maximum in August, you will have to pay for dental procedures without sharing the cost with Delta Dental until your plan year starts over the following January.

What is a Dental Benefits Premium?

This is the fee paid for your dental plan, which is usually a monthly charge. If your benefits are given to you through your employer, they likely pay either part of or all of the dental insurance premium.

Broaden your understanding of dental benefits basics with our Dental Insurance 101 post.