Learn About Important Dental Insurance Jargon from a Dentist

It’s almost the end of the year…you know what that means? It’s time to use your dental insurance benefits before they reset in 2018! Many people pay into their insurance but don’t take advantage of their benefits because they simply don’t understand how to. If you’re lost when it comes to insurance terms, your dentist is here to help you understand common dental insurance jargon to maximize your benefits.


Dental Terms You Need to Know

Annual Maximum

The annual maximum is the actual total dollar amount that a dental insurance plan will pay throughout a benefit period (usually a year) for an individual or enrolled family member.


Claims are the standard form that provides an itemized list or statement submitted by an individual or dental practice requesting that the insurance company pay of benefits for services provided. In many cases, your dental practice will help you submit claim forms.


An individual that has multiple insurance plans may be able to split costs between the primary insurance and the coinsurance. Typically, the primary insurance covers a larger amount and the coinsurance has the leftover obligation.


The copayment is the fixed amount of money a patient must pay during dental visits where services are rendered under certain dental benefit plans.


A deductible is the official dollar amount that each enrolled individual must pay for certain covered services before your dental insurance pays for benefits.


Dental services provided in a dental benefit plan are offered within in-network dentists, meaning you must see a dentist that works with your dental insurance company to avoid out of pocket costs. In-network dentists have agreed to participate in a plan and provide treatment according to certain administrative guidelines.


This is an administrative requirement that may require your dentist to submit a treatment plan to the insurance company before treatment begins, typically taking place when the insurance company is expected to cover charges that exceed an anticipated amount. Your dental insurance company will return the treatment plan with a layout of the patient’s eligibility, guarantee of the eligibility period, covered services, benefit amounts payable, application of appropriate deductibles, and/or copayment demands.


A premium is an amount charged by a dental insurance provider for coverage. If you pay into dental insurance through your job, the premium is usually taken right out of your check.

Preventive Services

A category of dental services that is typically covered by most dental benefit plans. The services include oral evaluations, routine cleanings, dental x-rays, and fluoride treatments. The services may vary according to your plan.


Use Your Dental Insurance by the End of the Year!

One of the best resolutions you can make is to keep a healthy smile throughout 2018—start the new year off with a shining, functional smile! Not only will you take advantage of your dental benefits (that you’ve been paying into), but your mouth will be healthier and stronger for whatever 2018 holds for you.

Although you may better understand dental insurance terms, your dentist is still here to answer your questions and help you submit insurance claims.


About Our Office

If you’re looking for a helpful dental practice that’ll get you the most out of your insurance plan before the end of the year, look no further! Zam Dental is thrilled to offer you comprehensive services and guidance through the benefits and claims process. Learn more about our financial options here!

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