Dental Insurance, I need help understanding coverage terms.
I was able to get a job that offers health and dental insurance. I never had dental insurance before so I do not understand a few of the terms or what they mean. I have to pick between two plans and let them know which one I want by next month.
So here are my questions: What is considered Preventive Treatment, Basic Treatment and Major Treatment? What type of procedures fall into those services? Both plans are saying they only pay a percentage of preventive, basic, and Majors so I kinda understand that. However what is a deductible? One plan said 50.00 and the other is 25.00 if that helps.
What do they mean by waiting periods. Also what is a 1000 max? I am really trying to figure out what all this means. Sorry this is all just going over my head.
Dental Insurance, I need help understanding coverage terms. ,
Tuesday, Apr. 27th 2010 9:00 AM at 9:00 am
For what is consider Preventive Treatment, Basic Treatment and Major Treatment Depends on the plan. Services can very in each depending on the insurance company. Normally they do lay that out in a chart.
I made a copy of such a plan that is offer on http://www.dental4less.com call Dental Dental so that you can get an idea.
Preventative Treatment
Diagnostic: Routine periodic examinations once in a 6 month period.
Preventative: Dental prophylaxis (teeth cleaning and scaling) once in a 6 month period (including application of topical fluoride for dependent children only).
Basic Services
Restorative: Amalgam, synthetic porcelain or plastic fillings Other: Space maintainers, recementation of crowns
Major Services
Endodontics: Pulpal therapy and root canals.
Periodontics: Treatment of diseases of the gums.
Prosthetics: Gold restorations, crowns, bridges, partial and complete dentures.
Oral Surgery: Extractions and other oral surgery, including pre- and postoperative care
Other: Pontics, repair of crowns and bridges, full and partial denture repair.
So as you can see Preventive treatment is mostly X-rays and Cleaning. Where Basic would be mostly filing and Major in this case is pretty much everything else
This is only an example. You need to read though both of your plan choices to see what they have in each section.
Tuesday, Apr. 27th 2010 9:48 AM at 9:48 am
When you are looking at plans that have a max limitation such as the one you are reviewing that says it has a 1000 max. That would be the dollar amount the insurance company is going to spend on your each year. So in your case it is a $1000.00 a year per person max. Maximum limitations can very I have seen them as low as 500 to as high as 2000.
Waiting periods are just what they sound like. Time periods in which the insurance company makes you wait until you get the service under the waiting period. As an example a plan could say you have a six month waiting
period for basic service. That would mean that you would need to be on the plan for six months before coverages are effective under the basic services.
A deductible is the dollar amount that you have to meat before coverages are effective. So you stated one was 50 and the other was 25 depending on which one you pick that is the dollar amount you would need to pay each year before the insurance start in.
Tuesday, Apr. 27th 2010 10:33 AM at 10:33 am
I really think the last two replies answered you coverage questions. However, I would like to give my words of advise.
Make sure you read both plans though if there is something that you do not understand, call the person who handles your insurance.
If your work does not have someone you can talk to about your plan choices then call the insurance company directly. Knowing and understanding the plan you pick is very important.