Dental Benefit Categories and Coverage

By Jill Feilmeier on August 26, 2014 in Insurance

Many dental plans offer 3 classes or categories of coverage. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.

Each class also specifies limitations and exclusions. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully or visit your dental insurance carrier's website to view your specific benefits.

Here are the typical levels in benefit plans:

Class I (usually called Diagnostic & Preventative)

• Diagnostic and preventive procedures are typically covered at the highest percentage (for example 90 – 100% of the allowable dental charge). Because of the preventive nature of dentistry, your dental insurer wants to make sure you get frequent check-ups and cleanings.
• These procedures encourage patients to seek preventive care, because such care can prevent more extensive dental disease or even dental disease itself.

Class II (usually called Basic)

• Includes basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example 50 – 80%).

Class III  (usually called Major)

• For major services, such as crowns and dentures, these procedures are reimbursed at a lower percentage (for example, 50%). These services are usually less frequent and have higher costs.
• Class III may have a waiting period before services are covered.

Limitations and Exclusions

• Dental plans are designed to help with part of your dental expenses. The typical plan includes limitations and exclusions, meaning the plan doesn't cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits.

If you want to find out more about your coverage specifics, log on to our website at DeltaDentalIA.com. There you will find your specific benefits and usage. Or, call us to talk with a customer relation representative at 800-544-0718.

No matter what type of a dental benefit plan you have, it's important to understand your plan offerings so that you can use your benefits to help improve your health.