Dental Insurance Dictionary: A Guide to Some of the Most Commonly Used Terms

Unless you work in the dental field or the field of insurance, it is likely you have heard or seen dental insurance terms used that you had no idea what they meant. You can always ask California Dental Group to clarify any expense, procedure, or term you see. In the meantime, read on to learn about some of the most common dental insurance terms used.

Common dental insurance terms

• Annual maximum. Your dental insurance will only pay a certain amount per year. This amount is the annual maximum. If you have a family dental plan, then the annual maximum may apply to each member or to the family as a whole.
• Co-payment. Depending on your insurance, you likely need to make a small payment when you receive care and your insurance will pay for the rest (or a portion of the rest). The small payment you are required to make at the time of service is called the co-pay.
• In-network. Most insurance companies cover a larger portion of the cost of dental treatment when their insured choose in-network providers.
• Covered services. Your dental insurance company should include a list of all treatments, procedures, and services they cover under your policy.
• Exclusions. Likewise, your policy should include exclusions. For example, they are not likely to cover what they see as cosmetic dental procedures such as teeth whitening.
• Deductible. This is the amount you pay out of pocket before your insurance company begins paying for services. The higher a policy’s deductible, the cheaper it generally is.
• Diagnostic services. This is a category of treatment types that do not generally require a deductible to be paid. For example, most plans cover two dental exams and cleanings per year with no deductible, though a co-payment is generally required.
• Lifetime maximum. Your policy may have a lifetime maximum after which it will no longer pay benefits. These cover the entire lifetime of the patient.
• Limitations. Similar to exclusions, limitations covers all the procedures that a policy does not cover. Limitations may include a specific type of procedure but limit how often it will be paid for.
• Premium. This is the cost the patient pays their insurer each payment period.
• Waiting period. Most dental plans do not take effect immediately. Instead, you will have a waiting period before you can begin most treatment types. This is to prevent a patient from only picking up insurance when they have a need for an expensive emergency need.

These are some of the most commonly used dental terms but it is not an exhaustive list. If you have questions about your insurance policy we are happy to help. We know how complex the process can be and we work with insurance every day. Call California Dental Group now at (800) 407-0161 to find out if we take your insurance.