Understanding Dental Policy Terminology
Posted: September 18, 2024
If looking at your dental policy overwhelms you, you’ve come to the right place. We understand that dental insurance terminology can be confusing. That’s why we’ve compiled a list of basic terms so you can feel more confident about your coverage and make informed decisions.
Glossary of Basic Dental Insurance Terms
The following basic terms are essential to understanding your dental insurance and its benefits:
- Annual maximum: The maximum amount a dental policy will pay in a calendar year.
- Coinsurance: The percentage of the bill you must pay after meeting your deductible.
- Copay: A fixed amount you’ll need to pay your dentist for their service.
- Deductible: The amount you must pay before your dental insurance kicks in.
- Effective date: The date you can begin using your dental coverage.
- Exclusions: Services not covered by your dental policy.
- In-network dentist: The dentist you must use to receive the highest coverage for their services.
- Premium: The monthly amount you pay for your dental plan.
- Rider: A change to your policy to provide additional benefits, like coverage for braces.
- Waiting period: How long you must wait to receive coverage for specific dental procedures.
Care Terminology
Most dental plans follow a payment structure to determine how much to cover for specific services. The following information gives you an idea of what to expect:
- Preventive care: Preventive dental care often includes routine exams, teeth cleanings and X-rays. Dental policies usually pay the total cost of preventive care, and you won’t pay a deductible for these services.
- Basic care: Basic care includes procedures to repair teeth or restore oral health. It may consist of tooth extractions and gum disease treatment. Dental policies usually cover 80% of the cost of basic care.
- Major care: Major care usually includes more complex procedures like oral surgery or dentures. Dental plans typically cover 50% of major care costs.
- Cosmetic procedures: Cosmetic procedures affect how your teeth look and include veneers and teeth whitening. Dental plans usually don’t cover the costs of cosmetic work. However, some policies may cover braces with a rider or waiting period.
How to Get Dental Insurance
Many types of dental plans are available in California, whether you want to supplement your health insurance or purchase a stand-alone plan. At Health for California, our agents can help you select a dental insurance plan that best meets your needs and budget. All you have to do is call us — we’re excited to help.
If you’re ready to explore dental coverage options, use our simple online application to shop for plans.