If you’re reading this right now, maybe your company is thinking about switching up dental insurance or looking to add dental benefits for the first time. Or maybe you're looking at a copy of a quote or new dental plan and trying to make sense of it all. Whatever the case, there’s a lot of information to take in around dental benefits, and probably some terms and concepts that might be unfamiliar to you. At Beam®, we’re convinced that dental care doesn’t have to be complicated or confusing, and we’re here to make things clear and easy to understand - transparency for the information generation.
So where should we dive in? That depends on what you already know and what you’d like to find out, but let’s play it safe and start with some basic terminology.
Dental plans typically include a deductible, most likely in the range of $25-50. A deductible is the amount that a member is required to pay before insurance benefits kick in. For example, if an individual deductible is $50, that member is required to pay for the first $50 of dental care before taking advantage of dental insurance. Deductibles for family plans are often limited to a family deductible. This means that if a family plan included a family deductible of $150, coverage would begin once the $150 deductible was met, even if the individual deductibles had not yet been met. In most plans, but not all, deductibles are waived for Diagnostic & Preventive services (see below). Why? Well, insurance companies want members to go to the dentist and get checked out and prevent major issues. Makes sense, right?
Additionally, plans will include a maximum payment, usually just called a maximum. The maximum is the highest dollar amount that a dental plan will cover in a given amount of time for an individual member. With an annual maximum of $1500, the dental plan will cover up to $1500 of dental services per person, per year. If the plan includes ortho coverage (read: braces), there will typically be two maximums, one for ortho and one for everything else. The ortho maximum is usually a lifetime maximum and the regular maximum is usually annual.
The next important concept you’ll want to make sure you understand are dental insurance service classes and how they differ from one another. The term service classes refers to the four broad categories of dental care, which are usually covered at different levels by dental insurance. These categories are:
- Diagnostic & preventative
- Basic services
- Major services
Here’s a simple chart to give an overview of the classes and I’ve included some additional detail below.
Keep in mind that the descriptions above can differ depending on individual plan design. For instance, fillings are typically included in basic services but are sometimes considered major services, and basic x-rays are usually considered diagnostic & preventative but fall under basic services in some plans. At Beam®, we try to make this clear for our clients, but whichever carrier you use, be sure to understand the plan details; it never hurts to ask.
Here is some additional info on service classes.
Diagnostic & Preventative: For many people, the majority of visits to the dentist will fall under the category of diagnostic & preventative, so let’s go over that first. Diagnostic & preventative covers many of the services a person receives during a routine visit to the dentist. Exams and cleanings are almost always included in diagnostic & preventative, and basic x-rays usually fall into this category as well. In many plans, sealants and fluoride treatment for children under age 14 are also considered diagnostic & preventative. If most of your visits to the dentist involve some combination of these services, you’re in luck. Diagnostic & preventative is typically covered at 100%, and often does not require the deductible to be met (but read the fine print!).
Basic Services: If you’ve ever seen a dentist for anything other than a routine cleaning and check-up, chances are you’ve received some form of basic service. Services such as fillings, basic gum disease treatment, extractions and sometimes root canals are typically included under basic services. If you anticipate needing coverage for basic services, we have good news! Basic services are usually covered at 80 or even 90%, meaning a member could pay as little as 10% of the cost.
Major services: This service level covers more complicated procedures, such as complex oral surgeries, dentures, implants, and crowns. Coverage for major services is typically more limited, but if major services are a priority, you can find a dental plan with coverage at up to 60%.
Orthodontics: If you had braces as a teenager or are the parent of a teen with braces, this category is probably (too) familiar to you. Ortho refers to braces associated treatments, and when it is included, is typically covered at 50%. The caveat here is that ortho often includes an age limit of 19, meaning that people over 19 years old are not eligible for orthodontic coverage.
Side note: you might see the procedures listed above described in more official-sounding terms like endodontics, periodontics, and prosthodontics. No need to get confused - endodontics most commonly refers to root canals, periodontics refers to treatment of the gums, and prosthodontics refers to dentures and implants. As for orthodontics, well, we trust you know what that is.
And there you have it! If you’ve made it this far, you should be able to look over a dental plan and understand the majority of what’s going on. There’s still more to dive into, but we’ll save that for next time.
This is the 2nd part of a four part series on understanding dental benefits for your small business. New posts will be released in the coming days.