Dental Benefit Basics: Common Terms Defined
If dental benefit terms confuse you, you’re not alone. A 2013 survey found that 51 percent of U.S. adults were unable to accurately identify common health insurance terms. In order to better understand dental benefits, it’s important to start with the basics. That’s why we’re breaking down 5 commonly confused dental definitions – plain and simple.
Coinsurance is the percentage you would pay for a dental procedure. Delta Dental of Wisconsin will pay a percentage, and the patient will pay a percentage as well. For example, if you have a filling and the percentage is 80% for Delta Dental, your percentage would be 20%.
A co-pay is a cost-of-sharing arrangement in which you pay a specific charge at the time of service. For example, $15 for a routine dental check-up.
A deductible is a specific dollar amount you pay before the dental insurance carrier pays their portion. Deductibles usually apply to basic or major treatment, not cleanings and exams.
Typically a monthly charge, a premium is the total amount paid to the dental insurance carrier for your coverage. Your employer may pay the premium in whole or in part.
Balance-billing occurs when a participating dentist bills an enrollee for amounts over and above the amount. Participating dentists agree to accept the fee as approved by Delta Dental as payment in full. Dentists may not bill an eligible Delta Dental patient for any difference or balance between the Delta Dental approved fee and the submitted fee. Non-participating dentists are not limited in the amount they may balance-bill.
What other questions do you have about dental benefits? Are there additional terms you’re confused about? Let us help by directing you to a list of common dental terms.
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