Common Dental Insurance Terms Explained

  • Author: Shelby Tatomir

Common Dental Insurance Terms Explained

Preventive dental care helps maintain a healthy mouth to avoid tooth decay, tooth loss, and other harmful issues.

Regular dental visits are encouraged because they help prevent problems. When your dentist catches decay and gum disease early, they can stop them from getting worse. This reduces your chance of needing complex and expensive dental work down the road.

That’s why dental benefits are based around preventive care – to keep you healthy in the first place.  Here are the highlights you need to know to understand your dental benefits:

How preventive care works in your coverage

Because preventive care is important to keeping you healthy, many Delta Dental plans cover 100 percent of routine preventive and diagnostic care. This includes dental care procedures like cleanings, exams, and x-rays.

If your dentist finds more extensive procedures are necessary – a cavity filling, root canal, or crown, for example - those procedures are generally covered only between 50 to 80 percent.

Be aware that a deductible — the amount you pay before your dental insurance kicks in — may apply to these services. Your coverage will depend on your specific dental plan.

The most important things for preventive care? Brush your teeth twice a day with fluoride toothpaste, floss regularly, and make and keep your regular dentist appointments.

What is a dental claim?

A claim is created when you get a dental procedure done. It's a document that notes the procedures performed while you were at the dentist. This document is sent to your insurance provider, Delta Dental. Our team members review the claim to ensure your benefits are applied correctly to the procedures to pay the claim.

What is a deductible?

The amount of money a member pays before Delta Dental starts to pay toward the cost of procedures is called your “deductible.” You must pay for your dental care until your plan’s deductible is met. In some cases, it’s for a plan year, in other cases it may be for the entire time you’re continuously covered by a plan.

Deductibles may not apply to regular exams, x-rays, and cleanings.  Your coverage will depend on your specific dental plan.

What is coinsurance?

Coinsurance is how you share the cost of dental procedures after you’ve met your deductible. Coinsurance, is a percentage you pay for the cost of a procedure or treatment.  Any coinsurance also depends on your specific dental plan.

What is an annual maximum?

This refers to the maximum amount of money your plan will pay for dental services in your plan year. If a member's plan is based on the calendar year, then the time frame for their annual maximum is from January to December.

If you reach your annual maximum in August, you will have to pay for dental procedures without sharing the cost with Delta Dental until your plan year starts over the following January.

What is a premium?

This is the fee paid for your dental plan, which is usually a monthly charge. If your benefits are given to you through your employer, the employer may pay some or all of the dental insurance premium.

Now that you know the highlights of dental insurance, what can you do to make the most of preventive dental care? That’s easy! Brush your teeth twice a day with fluoride toothpaste, floss regularly, and make and keep your regular dentist appointments.

Visit our online glossary if you want to go in for the deep dive on dental insurance terms.