We know dental insurance terms can be tricky to understand. This guide will help you better understand how dental plans work so you can get the most from your coverage.
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The best way to take full advantage of your dental plan is to understand its features.
There are two ways to review your coverage:
To get the most from your benefits, we encourage you to see a dentist who participates in your plan’s network. These are called “in-network” dentists. They provide services at discounted rates and file all claims paperwork for you. You get the best out-of-pocket savings when you see an in-network dentist.
If you choose a non-participating dentist, you’re responsible for making sure they complete your claim forms and send them to us.
We have four dental networks, designed for specific plans.
Here’s a breakdown:
Copayments and coinsurance
Most dental plans group covered treatments into three classes. Each class includes specific types of treatment that are covered at a certain percentage, or reimbursement level. Each class also specifies limitations and exclusions.
Here is what services are typically included in each class:
Class I procedures are referred to as preventive and diagnostic. They’re covered at the highest percentage (usually 100%). This makes it easy and affordable for patients to get care that helps prevent most dental diseases.
Class II includes basic restorative procedures like fillings, extractions, and root canals. These treatments are usually reimbursed at a slightly lower percentage than Class I services. For example, they may be covered at 70% instead of 100%.
Class III is for major procedures such as crowns, dentures, and fixed partial dentures. These services are usually reimbursed at the lowest percentage (typically 50%). Class III may have a waiting period before services are covered.
Class IV is for orthodontic treatment (braces). These services are usually reimbursed at 50% and may have a waiting period.