Dental Insurance: Making Sense of Your Benefits Package

It can be quite confusing trying to wade through the detailed benefits package your dental insurer just handed you. All those phrases seem deliberately worded to confound you. All care dental plan benefits packages are unfortunately often written by people who already know what all those words mean, and have trouble “translating” for normal folks.

Here are a few phrases you may encounter while perusing your dental insurance benefits package, and a real-world translation. Do not be embarrassed to ask for help if there is something you don’t understand.

Waiting periods: Simply put, this is the time a new member waits between the effective date of coverage for certain procedures. The waiting period varies for each insurance plan, depending on the size of the group and whether the group had prior coverage. Always check your benefits package carefully before you have any procedures done by your dentist. If it’s not an emergency, it will pay to wait for your coverage to kick in.

Usual, Customary and Reasonable fees: Each dental insurance plan sets its own price limits for procedures, to keep the costs down for everyone in the group. This doesn’t mean your dentist charges that amount for a procedure, simply that the insurance company will only reimburse that amount.

Typically, an in-network provider will not charge you the difference, because he or she has contracted with the insurance company to write off the difference in charges. You must ask your dentist before receiving any services if you must pay the difference out of pocket.

The “Missing Tooth” clause: This is sometimes called the “replacement” clause. The missing tooth clause simply protects the insurance company from paying for the replacement of a tooth that was missing before you were covered by the policy.

These clauses also protect the insurance company from paying to replace dentures, partials or bridges that were in place before coverage took effect, if those procedures were not satisfactory or otherwise need to be fixed. These clauses usually expire after a certain period of time, and you must check your dental insurance benefits package to find out about expiration.

Yearly maximums: These maximums represent the most a dental insurance plan will pay out in a particular year. Check your plan carefully so you know when your year begins and ends.

There is generally an individual and family maximum, depending on how many people are covered by the plan. Dental benefits you don’t use in a particular year do not roll over to the next, so be sure to take advantage of all the benefits you have in place.

We hope these definitions help you understand your all care dental plan insurance benefits package a little better. While it can be confusing to read all those definitions, always know you can call your insurance company or ask your human resources director for help. Dental insurance is great coverage, so use it to keep yourself and your family healthy all year long.