Common Terms Dental Insurance Explained

Posted Oct 2019

By Delta Dental of Arkansas

Tagged understanding dental benefits

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Take less than four minutes to understand what dental benefits are and how they work.
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:

Get to know common terms in your dental plan to better understand how to put your dental coverage to 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. Click here to learn more about your dental plan’s coverage.

*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 don’t apply to regular exams, x-rays, and cleanings. Preventive care services like cleanings are covered 100 percent right off the bat, even if your deductible hasn’t been met yet.

Sign into your member portal or review your member ID card to see what your deductible is.

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.

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 a member's plan is based on the calendar year, then the time frame for their 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.

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Posted by Delta Dental of Arkansas



Posted by Delta Dental of Arkansas

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