It can be very difficult to understand the insurance plans and the numerous possibilities available at times. In order for members to fully utilize their dental coverage, Delta Dental Insurance has supplied the information on this website to help them grasp the fundamentals of dental insurance and all of its benefits.
If you are a member of any other insurer, such as Delta Dental, Aetna, Cigna, Metlife, Principal, Guardian, etc., please visit your insurance provider website for more information about your specific dental benefits and coverage limits.
You can contact us regarding your coverage and we will be happy to help you understand the details of your particular plan so you know what services are fully covered or what your out-of-pocket expense will be for any procedure that is partially covered.
Basics Of Your Insurance Plan
The majority of dental insurance firms offer a wide range of features and possibilities. There may be friends or coworkers who also have dental insurance, but their plans could not be the same as yours.
It’s possible that your Kent dentist does not “participate” in the dental plan’s network. In that case, your dentist will file your claim. In that case, you might be liable for paying your dentist and filing your insurance claim to Delta Dental or another company.
If you qualify for benefits under more than one group dental plan, the total paid by all of the plans together will not go beyond 100% of your dental costs. Dependent benefits differ from plan to plan. Pay close attention to any specific clauses and to language about dependents.
Dental benefits are determined during a “benefit period,” which might vary from a calendar year to one that is generally one year long. To find out when you might be getting close to your deductible payments or plan maximums, check your benefits information.
Key Concepts & Terms Used
What are Annual “Maximums”?
Most dental insurance policies have a yearly dollar cap. This is the most money a dental plan will contribute to the price of dental care during a certain benefit period. With a few exceptions, benefit periods are usually from January to December. Over the annual maximum, the patient is individually liable for any further expenses. To make the most of your advantages for the year, our dental practice will assist you in organizing your treatment. To learn more, get in touch with us.
What are Plan “Deductibles”?
Similar to your auto insurance, most insurance plans have fixed dollar deductibles. Before your benefit plan will cover some of the cost of your dental care, you will first need to pay a portion of it out of pocket. How your deductible functions will be covered in your plan’s information. What categories in an insurance plan the deductibles are applied to varies slightly. For instance, whereas other dental insurance plans do not, some do apply the deductible to diagnostic or preventive procedures.
What is a “Coinsurance?”
The coinsurance you pay is a portion of your out-of-pocket expenses. Coinsurance clauses are common in insurance policies. This means that you are responsible for the remaining balance after the benefit plan deducts a specified portion of the cost of your treatment. Even after the deductible has been met, it is paid.
What are “Reimbursement Levels”?
Three levels of coverage or service are frequently offered by dental insurance. Each class offers a certain form of treatment, which is normally covered to a certain extent.
- Class I procedures are often covered at the highest percentage because they are preventative and diagnostic. This provides patients with a financial incentive to seek out early or preventative therapy because such care can stop dental disease itself or even more severe forms of the condition.
- Basic treatments including fillings, extractions, and periodontal therapy are included in Class II and occasionally reimbursed at a slightly lesser rate.
- Major services are under Class III, which is often reimbursed at a reduced rate. Under the Comprehensive plan, a 12-month waiting period is in place.
Can I Estimate My Dental Costs for Treatment?
You can ask your dentist to fill out and submit a request for a cost estimate, also known as a pre-treatment estimate, if your dental care will be comprehensive. By doing this, you’ll be able to anticipate the operations that are covered, the amount the benefit plan will contribute to your treatment, and your financial obligation. An estimate given prior to treatment does not ensure payment. Following the completion of the services and receipt of a claim for payment, Delta Dental will determine your payment based on your current eligibility, the amount of your annual maximum that is still available, and any deductible requirements.
What Are “Limitations and Exclusions”?
Dental insurance programs are intended to cover a portion of your dental costs but may not always do so. The average plan has exclusions and limitations, so not all aspects of dental care are covered. This may have to do with the kind or quantity of procedures, the quantity of visits, or age restrictions. You can create reasonable expectations about how your dental plan will benefit you using the information in your dental insurance plan booklet.
According to clinical standards used by Delta Dental’s qualified dentist consultant staff, allowances for some operations covered by your insurance may be restricted or denied. For the purpose of determining benefits, your insurance company maintains written requirements.
You may obtain a copy of such guidelines for:
Basic benefits, Crowns, inlays, onlays and cast restoration benefits, Prosthodontic benefits and Ortho Benefits
Dentists at Seablue Dental of Kent are in-network preferred providers for most major insurance plans – Delta Dental, Aetna, Cigna, GEHA Connection Dental, Guardian, Metlife, Principal, Humana, HMA, Dentegra, Regence Blueshild, United Healthcare, United Concordia, union plans and many others. Click here to browse the list of dental insurances we accept or contact us for more information. If you have no dental insurance coverage, we offer in-house membership plans as well as multiple financing options for smaller monthly payment plans!
