What is an Annual Maximum?

annual maximum

What is an Annual Maximum?

The annual maximum is the dollar amount your dental insurance plan pays within one benefit period, which is usually one year. A benefit period can start at any point in the calendar year, but typically last 12-months before starting over. When this happens, your annual maximum resets.

Does my dental insurance plan have an annual maximum?
    Most of our plans have an annual maximum. You can find out what your annual maximum is – and which plan you’re on – in a few ways:
  1. Log in to MySmile®: The easiest way to find out information about your dental plan is by logging in to your MySmile account and selecting “Coverage Overview”
  2. Review your Benefit Booklet: When you signed up for dental insurance, your employer likely provided you with a hard copy of all your plan’s information. This booklet will tell you everything about your insurance plan, including whether it has an annual maximum and how much that is.
  3. Contact Customer Service: You can call our customer service team to get information on your dental plan, including your annual maximum, by dialing 1-800-554-1907. You can also reach us via text at 833-604-1246.
Take control of your dental coverage! With MySmile®, you get access to important plan information – like your annual maximum – with just a click of a button. Get started today!

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What dental treatments affect my Annual Maximum?

Most dental treatments i.e., crowns, root canals, and fillings will affect how much annual maximum you have remaining for your benefit period.

85 percent of our members never reach their annual maximum

This is why it’s important to keep track of your annual maximum, so you know you’re making the most of your benefits, which can cover a wide range of your dental costs.

However, for many of our plans, preventive care services like exams and cleanings are covered 100% and don’t count towards your annual maximum. This means that your annual maximum can go toward paying for more costly procedures, which could mean that you pay less out-of-pocket*.

What is the difference between an Annual Maximum and a Lifetime Maximum?

The lifetime maximum is total dollar amount your plan will ever pay toward the cost of certain dental procedures. The most common dental treatments with lifetime maximums are orthodontia and TMJ. This does not reset when your benefit period starts over.

*Preventive Care coverage varies by plan and is subject to limitations and exclusions. Please log in to your MySmile account or review your Benefit Booklet for a full breakdown of coverage.