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Dental Insurance Information
With all insurance plans, you will always have a deductible and with dental insurance it can vary. Here is a basic understanding of how it could work:
Deductible– Typically can be $50 or $100. This is applied and paid out of your pocket when you have your first appointment for dental treatment like a crown or filling. Most plans do not apply this deductible toward your exams and cleanings, therefore no money is due from you during these types of appointments.
Second, is an annual maximum benefit- This is typically and can range from $1000.00 - $1500.00. Most plans are calendar year. When the insurance has paid benefits up to this amount you are cut off until next plan year. On January 1st of the next year your maximum is available to you again.
Third you have the annual maximum benefit is paid out in percentages depending on the type of service you have at the dentist. This is what you will Typically see:
Type 1 services (Preventative) which can have 100% coverage - exams, x-rays and cleanings, fluoride and sealants for kids up to a certain age.
Type 2 services (Basic restorative) which can have 80% coverage - fillings, root canals, extractions, periodontal scaling and root planning (deep cleanings).
Type 3 services (Major restorative) which can have 50% coverage - crowns, build ups, posts, dentures, bridge work.
While shopping for a plan make sure to look for in your group or individual plan are the following "exceptions":
WAITING PERIODS: With these periods, you have to wait 6 months from your effective date on the group dental plan for Type 2 services to be covered!
MISSING TOOTH CLAUSE: If the tooth was missing prior to your effective date with the group plan, too bad. They are not going to pay to replace it with a bridge or implant.
FREQUENCY: The group plan allows certain services at certain intervals. Cleanings every 6 month plus 1 day. (I'm not kidding, have your cleaning 1 day too soon and your insurance won’t cover it.) Full sets of x-rays are usually limited to every 3-5 years. That means if you switch dentists you want to have those x-rays sent over before you arrive.