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