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A Glossary of Popular Dental Plan Terms
Even if you clean your teeth every day and follow a flossing routine, you may wish to get an individual dental health plan or one for you and your family. You’ll likely see these terms in different insurance plan contracts.
Annual maximum – Your annual maximum is the highest cost of coverage that a dental plan will offer yearly.
Benefits – A benefit may come in terms of a percentage discount or full coverage minus a co-payment.
Co-payment – This is the amount you pay at the time of care. It is usually a somewhat cheap amount, such as $25 for a root canal or $20 to have them fill a tooth cavity. Your co-payment may increase for an expensive procedure, such as getting braces.
Diagnostic and preventative services – Services such as x ray exams and oral evaluations fall under the category of diagnostic and preventative. You usually pay the same percentage for all of these services.
DHMO – A Dental Health Maintenance Organization (HMO) plan is much like a medical HMO. You see designated providers, pay copayments, and receive free routine check-ups. DHMOs often have an annual maximum and affordable premiums.
Lifetime maximum – The total amount that a plan will pay during the course of an individual lifetime for certain services, such as orthodontic treatment, is the lifetime maximum.
Limitations and exclusions – Each insurance plan will have different limitations and exclusions, or procedures for which they don’t extend coverage. Bleach jobs to whiten enamel, for example, may not be covered.
Major services – Your contract will give a set percentage discount on major services. Crown and denture mold procedures often fall into this category.
PPO – A Preferred Provider Organizations (PPO) plan allows you and your family or group to see a certain roster of dentists. Premiums are usually higher for PPOs.
Dental insurance is often held separately from other health insurance. However, it tends to work in a similar manner. Affordable coverage is most often acquired through an employer. However, some employers that offer health insurance may not offer dental coverage.
Individual and family plans are available. Another alternative is discount dental plans, where individuals sign up to obtain cheaper treatment from dentists registered with the plan. This is not technically insurance. Also, dental insurance tends to cover less than regular health insurance. Health insurance may also cover major dental work, such as a tooth lost in an accident, or work related to other medical conditions, such as enamel weakness from celiac disease.
Dental insurance generally covers essential care such as routine checkups. It may or may not cover dentures, but will usually cover cleanings. Fillings, crowns and root canals are generally covered, as are X rays. However, it seldom covers orthodontic treatments such as molds and braces or bleaching and whitening procedures that are generally considered cosmetic. Obviously, it does not cover things done at home such as flossing.
Plans may be either HMO or PPO, both working the same way as with regular insurance. PPO plans tend to give members more choice as to where to go for treatment. Group plans are generally cheaper than ones obtained by individuals and often offer better benefits. Most will cover the employee's family. Most insurance plans have a waiting time before services are covered, usually three months for fillings and six for more serious treatment such as root canals or wisdom tooth removal.