Carryover Benefits Explained

If you understand the basics of dental coverage, you notice a trend: Dental insurance plans tend to focus on preventive care. Typically, they’ll pick up the entire tab for routine checkups and cleanings but pay less for costlier procedures like root canals and oral surgery.

That’s where carryover benefits come in handy. Carryover benefits give you the ability to carry over a portion of unused annual maximums into the next year. This helps pay for more expensive dental services if needed.

Delta Dental of Arkansas offers carryover benefits for all group dental plans and for all individual/family plans except the lowest-priced, basic individual plan.

Let’s look at the specifics and even do a little math to illustrate how carryover benefits can help you save money.

What are Carryover Benefits?

Carryover benefits are a type of reward from your dental insurance company for taking good care of your teeth and scheduling regular dentist visits.

Carryover benefits refer to a portion of your unused annual maximum that you accrue or “carry over” from one plan year into the next. The amount is added to the annual maximum, increasing your financial benefit for dental expenses in Year 2. If you don’t use your annual maximum in Year 2, you will be able to carry over a certain amount into Year 3, again boosting your annual maximum.

This can continue until

• You exceed your dental claims past a certain point, called a “threshold” or
• You reach an expiration or reset point as specified by your plan, e.g., switching group plans or experiencing a break in coverage.

How Do Carryover Benefits Work?

Dental insurance plans that offer carryover benefits will usually require you to meet certain conditions. These conditions might include:

1. You must receive at least one covered dental service per year, such as a preventive care exam and a professional cleaning, AND
2. Your claims must not exceed a certain dollar amount or percentage of the annual maximum.

Example of Carryover Benefits from Year 1 to Year 4

Let’s suppose:

• A member has an annual maximum of $2,500.
• His dental plan allows him to carry over up to $625 per year of the unused annual maximum IF

1. He receives at least one covered dental service per year, AND
2. His total claims do not exceed the threshold of $1,249 per year.

In Year 1, the member qualified for a carryover benefit because he met the conditions of receiving at least one covered dental service and not exceeding the annual claims threshold of $1,249. His total claims were only $200.

In Year 2, the member again qualified for a carryover benefit because he met the conditions of receiving at least one covered dental service and not exceeding the annual claims threshold of $1,249. His total claims were only $375.

In Year 3, the member needed extensive dental work, and his total claims exceeded the threshold of $1,249. The member did not qualify for a carryover benefit in Year 3, but was able to use some of his carryover balance to pay for the extensive dental work. The remaining carryover balance of $250 after all dental work was completed is added to the annual maximum of Year 4.

In Year 4, the member has a total annual maximum of $2,750 ($2,500 plus a $250 carryover balance.) Depending on his total claims costs, he may qualify for a new carryover benefit for Year 5.

How Do Carryover Benefits Save You Money?

The example above shows how carryover benefits can save you money.

Our hypothetical member in Year 3 saved $1,000 in out-of-pocket expenses because his annual maximum had increased to $3,750 thanks to the carryover benefits of Years 1 and 2. Without the Carryover Benefits, his annual maximum would have been capped at $2,500 each year, causing him to pay considerably more for his dental work in Year 3. 

Bonus: Taking advantage of carryover benefits does not impact the monthly premium rates.

Limits and Exclusions

Policies differ. Check yours for specifics like

• Eligibility of dependents. Some plans will only cover the subscriber; others also include covered dependents.
• Individual vs. family carryover benefits. If your plan includes covered dependents, does each member have to accrue his/her own Carryover Benefit or is it applied to the whole family?
• Waiting periods. You may have to be a plan member for a minimum amount of time before accruing carryover benefits.
• Orthodontia. Carryover benefits typically cannot be used for orthodontia.
• Loss of eligibility. You may become ineligible to qualify for carryover benefits after a break in coverage or when your carryover balance has reached a certain amount.
• Benefit forfeiture. You may lose your carryover balance if you move to another group plan or don’t receive at least one covered dental service per year.

Bringing Healthy Smiles to Arkansans Since 1982

Delta Dental of Arkansas has championed the oral health of Arkansas since 1982. If and when you’re ready to consider dental or vision coverage for yourself or your family, check us out. We offer a variety of plans with competitive rates, different levels of benefits to suit your needs and access to one of Arkansas’s largest networks of providers.

Interested in group coverage? More info here.