Understanding Your Annual Maximum

annual maximum


 

Most of our plans carry an annual maximum. To check which plan you’re enrolled in and whether or not it carries an annual maximum, log into MySmile® or review your Benefit Booklet.




Does my plan have an annual maximum?

Your annual maximum is the dollar amount limit your dental plan pays within one benefit period, which is usually one year.  




How is that different from a Lifetime Maximum?

Once your lifetime maximum is spent, it is not reset. Usually this applies to treatments like orthodontia that are unlikely to be repeated. However, if your plan changes (Ex: starting a new job, switching employers, etc.), the lifetime maximum will reset.

Did You Know?


Nearly 85% 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.

 



Do All Treatments Apply to an Annual Maximum?

Most treatment costs apply toward your annual maximum. But copays and deductible costs don’t.

More good news? On many plans preventive services, like oral exams and x-rays DON’T count toward your annual maximum. So, your coverage dollars stretch further.

(To check what does and does not apply toward your annual maximum, log into MySmile® or review your Benefit Booklet.)




How does the Maximum Wellness plan affect Annual Maximums?

If you are enrolled in our Maximum Wellness plan, you actually can increase your annual maximum by going to the dentist!

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Questions? Talk to Your Dentist

If you’re ever concerned about your annual maximum, make sure to talk to your dentist about potential costs before scheduling treatments. If necessary, you may even be able to set up a treatment plan that spreads your out-of-pocket costs while still meeting your dental needs.