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SW Nebraska Dental Center
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Let’s Talk About Dental Insurance: Volume II

September 16, 2019
Posted By: Katie Schutte

Let’s Talk About Dental Insurance Series Volume II:

Let’s talk benefit maximum versus deductible and calendar year versus benefit year

By Katie Schutte

Welcome to volume II of our mini blog series about all things dental insurance! Last week we talked about where insurance policies come from and who you need to talk to if you are unhappy with your policy. This week we are focusing on some dental insurance lingo and breaking down common terms so you can understand your dental policy better. By educating yourself regarding your dental policy, you will limit the amount of surprises on your explanation of benefits.

Let’s talk about benefit year versus calendar year.

Dental insurance policies run either on a calendar year OR a benefit year. For a policy that runs on a calendar year the maximum and deductible or service frequencies start over January 1st. If your policy runs on a benefit year then it will be whenever your benefits went into effect. For example, July 1, 2019-July 1, 2020 could be your benefit year. It can be imperative to get as much treatment as possible done during the benefit period to maximize dental benefits.

Let’s talk benefit maximums.

The benefit maximum is the amount of money a dental insurance carrier will pay during your benefit period. On average most policies are $1,000.00, however, they could be more or less depending upon your policy. If you are lucky, your policy does not have a maximum. After the benefit maximum has been reached, the carrier will not pay any more money towards treatment. However, certain policies throw in a contingency that preventive treatment, such as cleanings, do not count towards the annual maximum. However, to know this for sure, you would need to call and check with your insurance carrier.

Let’s talk about deductibles.

The deductible is a certain dollar amount that the patient must pay before the insurance company will pay. For most policies, the deductible will only apply to treatment, such as fillings or crowns, however some policies have the deductible apply to any service. There is an individual deductible and a family deductible. The individual deductible is usually $25 to $50 a person and the family deductible is usually three family members’ individual deductibles; SO if you have a family of four, the fourth person wouldn’t have to meet a deductible once the other 3 were met.

Confusing right?!

We hear you. THE GOOD NEWS: We offer Education. We educate our patients on their benefits and give them the tools to decipher their policies. By understanding the ins and outs of their insurance, they know exactly what will be covered and not covered.

However, even though we try our best, we cannot guarantee that your insurance will pay, that is why we stress that it is so important that we empower you to know about your policy. That way we can work hand in hand with you to maximize your dental insurance benefits.

Stay tuned for another volume of “Let’s talk about Dental Insurance”. Next week we are talking about those common dental insurance clauses and limitations! If you have any questions please give our office a call at (308) 345-2273 or email us at [email protected]

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