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Dental Insurance Terms to Know

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Key Definitions within your PPO Dental Insurance.  Contact our offices if you have ay questions.

Annual Limit or Maximum:  This is the amount of dental insurance you get per year.  With dental insurance, you only are covered up to a certain amount each year.

Annual Deductible:  This is the amount that you must pay each year before your insurance kicks in.  Something you should be aware if your deductible applies to preventative work or just for basic and major work.

Preventative Work:  Typically exams, X-Rays, and Cleanings.  This is usually covered at 100% and the deductible does not typically apply.

Basic Work:  Typically this applies to fillings, extractions, root canals, deep cleanings, and denture adjustments.  This is typically covered between 70-90%.

Major Work:  Typically this applies to crowns, bridges, implants, dentures, and partial dentures.  Coverage for this is typically 50% but often is up to 80%.

Wait Period:  How long you have to wait as the patient from when you get on your dental plan until you can have certain coverage.  Some plans have wait periods for certain procedures.  We can check this for you.

Missing Tooth Clause:  If your tooth was missing before you got onto your insurance, this clause prevents you from having coverage in replacing this tooth whatsoever.

Maxed Out For the Year: You used all of your dental benefits for the year.

Replacement clause:  How long you have to wait until you have the same work redone.  Examples include a replacement crown or denture.

 

 

 

 

 

 

 

Downgrade:  Insurance companies sometimes pay lower percentage for work done on your molars, for example fillings and crowns.

Patient Portion:  The amount that you are responsible for as your insurance will cover the rest.

Uncovered Benefit:  This is a procedure that the insurance company does not provide any coverage for whatsoever.

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