Dental Insurance Information

By purchasing a dental insurance plan, you enter into a contract with the company. They agree to pay certain amounts for certain procedures and you assume responsibility for what they do not cover. Generally, the terms of your coverage are spelled out in the contract. Different plans approach coverage in different ways. Some require you to reach a deductible before paying anything, while others pay a percentage immediately. Understanding the different terms associated with your insurance plan can help you figure out your coverage.

Deductible

A deductible is a minimum amount of money you need to pay towards dental care before your plan coverage starts. Most plans do not require a deductible for diagnostic or preventive services.

Annual Maximum

Many plans have a cap on how much money they will pay for any given treatment during the year. Anything over that amount becomes your responsibility. For example, if your plan has a annual maximum of $2,000 and your dental expenses exceed $3,000, you have to pay the additional $1,000. In some cases, you can raise your annual maximum to better suit your needs. There is usually a separate lifetime maximum for orthodontics. 

Least Expensive Alternative Treatment (LEAT)

If your plan has a LEAT clause, the company will only pay for the least expensive treatment available for any given condition.

Frequency Limitations

Some plans have limitations on how often they will cover a certain procedure. Generally, there is a set number of procedures permitted in a specific period. For example, most dental insurance plans will only cover two professional cleanings every 12 months, or one cleaning every six months.