Having dental insurance is important for your oral and overall health. However, if you’re like most people, taking the time to fully understand dental insurance terms is a big (but valuable) chore.
Don’t let confusing insurance terms keep you from understanding your coverage. In this article, we explain some of the most important dental insurance terms to help you feel confident when choosing your plan.
To get the full value from your dental insurance plan, it’s important to be familiar with the following commonly used terms:
The set dollar amount you are responsible for before your dental plan begins to pay for covered services is called a deductible. However, you only have to meet your deductible once in a plan year.
A dental claim is information the dentist submits to the dental plan to get paid for services performed on a patient. It outlines the procedures that were performed while you were at the dentist and how much they cost. This document is sent to your insurance provider for review to ensure your benefits are applied correctly to the procedures.
Coinsurance and copays are how you share the cost of dental procedures after you’ve met your deductible. A copay is a set dollar amount you are required to pay your dentist for a service.. Coinsurance is ﬁxed percentage of a dental treatment cost that you share with your dental plan. For example, Delta Dental may pay for 80% of a given service, while you are responsible for 20%. Most plans generally have a copayment or coinsurance, but not both.
This refers to the maximum amount of money your plan will pay for dental services in your plan year. If your plan is based on the calendar year, then the time frame for your annual maximum is from January to December. For example, if you were to reach your annual maximum in August, you would have to pay for dental procedures without sharing the cost with your insurance provider until your plan year starts over the following January.
A dental insurance premium is the amount you pay for your dental plan, which is usually a monthly charge. If your benefits are given to you through your employer, they may pay either part or all of the dental insurance premium.
The terms explained in this article are just a few dental insurance terms that you may encounter as your coverage begins. If you have any questions about them or any other terms, be sure to reach out to our customer service team or check out our glossary of dental terms.
*Updated October 2023