Dental Insurance Articles
Dental Insurance Maximums And How They Are Calculated
2010-09-02
With the rising costs of dental treatment and orthodontia, dental insurance is no longer a luxury but a necessity. If you're planning on obtaining dental insurance to cover regular cleanings and more expensive procedures such as crowns and dentures, it's important to know how your potential insurer handles dental insurance maximums. Being knowledgeable about your maximums ensures you'll know how much coverage you can expect in a given year, and in turn what procedures you can plan for.
A yearly maximum in dental insurance is the maximum amount that an insurance company will pay for an individual or family's dental procedures, or plans in a given year. Depending on the dental insurance company, this year could be a calendar year, fiscal year or other predetermined year.
Many companies have maximums of $1,000. Your dental insurance maximum will renew each year that you're covered. Unfortunately, any unused benefits will not rollover to the following year. As a result, it's important to plan your dental treatment accordingly so you don't hit your maximum too early and need to stop in the middle of treatment or refuse a particular service.
Once you're aware of what your insurance company considers a year, you can plan out future dental procedures and work. However, you should exercise caution when attempting to delay a procedure or have a procedure done quickly in order to fit it into a calendar year and ensure you're covered under your plan's maximum. Some plans have waiting periods and other restrictions to discourage this type of planning.
Insurance maximums are calculated based on the amount of money the dental plan purchaser-whether it is an individual or a corporation-is willing to reimburse through the insurance company. Normally, the maximum will be the top amount in a given year that your employer is willing to pay the insurance company for coverage.
It's important to note that insurance maximums are the maximum amount in dollars the insurance company will pay-not necessarily the value of the work you received. Also, you should note what percentage of your desired procedure is included in your yearly maximum. For example, many dental plans will pay 100 percent of a cleaning, but only a percentage of a crown, bridge or denture. The percentage covered is important because this number shows you what amount counts toward your yearly maximum.
You dental insurance maximum is one of the most important pieces of information you can learn from your policy. Your choice of dentist, treatment plan and estimated costs are all affected by your insurance maximum. Being aware of your plan's maximums can save you time and money, as well as ensure you get the care you need when you need it.