Dental Benefit Categories and Coverages
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.
Here are the typical levels in benefit plans:
Class I (usually called Diagnostic & Preventative)
Procedures are diagnostic and preventive and typically are covered at the highest percentage (for example 90 - 100% of the allowable dental charge).
This type of coverage gives patients a financial incentive to seek preventive care because such care can prevent more extensive dental disease or even dental disease itself.
Class II (usually called Basic)
Class II coverage includes basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example 70 – 80%).
Class III (usually called Major)
Major services include crowns and dentures. This coverage is usually reimbursed at a lower percentage (for example, 50%).
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, log on to our website at DeltaDentalAR.com. There you will find details on your benefits and usage. Or, call us to talk with a customer service representative at 800-462-5410. 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.