Understanding the insurance plans and various options offered can be very confusing at times. Information listed on this page is provided by Delta Dental Insurance to help the members understand the basics of dental insurance & all of its features so the patients can take full advantage of their dental coverage.
For further details about your individual dental benefits and coverage limits, please visit your insurance provider website if you are a member of any other insurance such as Delta Dental, Aetna, Cigna, Metlife, Principal, Guardian etc.
You can contact us regarding your coverage and we will be happy to help you understand the details of your particular plan so you know what services are fully covered or what your out-of-pocket expense will be for any procedure that is partially covered.
Basics Of Your Insurance Plan
There are a lot of different features and variety of options offered by most dental insurance companies You may have co-workers or friends who also have dental insurance, but their coverage may differ from yours.
Your dentist at Seablue Dental of Kent may not “participate” in the network for your dental plan. If your dentist does, he or she will submit your claim. If not, you may be responsible for paying your dentist and submitting your claim to Delta Dental or another insurance carrier.
If you are entitled to benefits from more than one group dental plan, the amounts paid by the combined plans will not exceed 100% of your dental expenses. Benefits for dependents vary from plan to plan. Pay particular attention to special clauses and to language about dependents.
Dental benefits are calculated within a “benefit period”, which is typically for one year but not always a calendar year. Check your benefits information so that you know when you might be approaching your deductible payments or plan maximums.
Key Concepts & Terms Used
What are Annual “Maximums”?
Most dental plans have an annual dollar maximum. This is the maximum dollar amount a dental plan will pay toward the cost of dental care within a specific benefit period. Benefit periods are typically Jan-Dec except a few exceptions. The patient is personally responsible for paying costs above the annual maximum. Our dental office will help you plan your treatment so you can utilize your maximum benefits for the year. Contact us for more details.
What are Plan “Deductibles”?
There are specific dollar deductibles for most insurance plans similar to your auto-insurance. You personally will have to satisfy a portion of your dental bill before your benefit plan will contribute to your cost of dental treatment. Your plan information will describe how your deductible works. Insurance plans vary a bit on what sections the deductibles get applied to. For instance, some dental plans will apply the deductible to diagnostic or preventive treatments, and others do not.
What is a “Coinsurance?”
What you pay is called the coinsurance, and it is part of your out-of-pocket cost. Many insurance plans have a coinsurance provision. That means the benefit plan pays a predetermined percentage of the cost of your treatment, and you are responsible for paying the balance. It is paid even after a deductible is reached.
What are “Reimbursement Levels”?
Many dental Insurances offers three classes of coverage or service. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.
Class I procedures are diagnostic and preventive and typically are covered at the highest percentage. This gives patients a financial incentive to seek early or preventive care, because such care can prevent more extensive dental disease or even dental disease itself.
Class II includes basic procedures – such as fillings, extractions and periodontal treatment – that are sometimes reimbursed at a slightly lower percentage.
Class III is for major services and is usually reimbursed at a lower percentage. There is a 12 month waiting period under the Comprehensive plan.
Can I Estimate My Dental Costs for Treatment?
If your dental care will be extensive, you may ask your dentist to complete and submit a request for a cost estimate, sometimes called a pre-treatment estimate. This will allow you to know in advance what procedures are covered, the amount the benefit plan will pay toward treatment and your financial responsibility. A pre-treatment estimate is not a guarantee of payment. When the services are complete and a claim is received for payment, Delta Dental will calculate payment based on your current eligibility, amount remaining in your annual maximum and any deductible requirements.
What Are “Limitations and Exclusions”?
Dental plans are designed to help with part of your dental expenses and may not always cover every dental need. The typical plan includes limitations and exclusions, meaning the plan does not cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits. Your dental insurance plan booklet can help you develop realistic expectations of how your dental plan can work for you.
Allowances for some procedures covered under your benefits may be subject to limitation or denial based upon clinical criteria applied by Delta Dental’s licensed dentist consultant staff. Your insurance maintains written guidelines for the use of clinical criteria in making benefit determinations.
You may obtain a copy of such guidelines for:
Crowns, inlays, onlays and cast restoration benefits
Dentists at Seablue Dental of Kent are in-network preferred providers for most major insurance plans – Delta Dental, Aetna, Cigna, GEHA Connection Dental, Guardian, Metlife, Principal, Humana, HMA, Dentegra, Regence Blueshild, United Healthcare, United Concordia, union plans and many others. Click here to browse the list of dental insurances we accept or contact us for more information. If you have no dental insurance coverage, we offer in-house membership plans as well as multiple financing options for smaller monthly payment plans!