Dental Coverage – What Your Teeth Should Be Covered With?

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Dental Coverage – What Your Teeth Should Be Covered With?
Dental Coverage – What Your Teeth Should Be Covered With?

After nearly a two-year pandemic/lockdown, it has been rough for many us. From simple day to day tasks like going to the grocery store or even a doctor’s visit. There were many things to consider before even heading out the door. Now with the majority of the population vaccinated it puts most of us at ease to know our communities are doing their part in helping each other out.

One of the things that some patients missed out on was their dental appointments. Although your oral health should not solely rely on the type of dental coverage you may or may not have, it can play an important factor. With so many different plans and policies, it can be overwhelming to find one that suits you. Knowing your coverage can be beneficial because it will allow you to maximize your benefits and make sure you are at optimal oral health. So, what are some of the main things you should know about your dental coverage?

Maximum – This is the overall allotted amount set by your policy that you are entitled to every benefit year. The amount can range depending on your policy. There are even some plans that don’t have a set maximum. This can give you a good idea of much you have to spend especially if you have any extensive dental work that may be required.

Co-Pay – This is the amount you are required to pay as a percentage of the total cost of any treatment. For example, if your plan covers 80%, your co-pay will be 20% out of pocket. Depending on financial agreements, you will either pay the full amount on the date of service, this is called non-assignment of benefits, or you will only be responsible for the percentage your insurance doesn’t cover, also known as assignment of benefits. Some policies allow for an assignment of benefits, and some plans do not. This is important to know as it will determine you out of pocket cost at each appointment.

Benefit year – Most plans will run on a calendar year. This means on January 1st to December 31st of every year, your plan is active and resets the following year on January 1st. This is usually when your plan maximum resets to its full amount. Some plans may run on an anniversary date, which means when the plan was initiated such as February 1st or March 1st and would subsequently reset the following year on the same date.

Frequency – The biggest confusion regarding dental insurance is frequency. This is the number of times you are allowed a certain type of service under your plan. This includes services like polish and fluoride, recall exams, complete oral examinations and x-rays. This frequency can also vary based on your policy. Some may allow once every six months while others can allow once every nine months.

Scaling units – This is the number of units you are given for your hygiene appointments. Hygiene is based on units of time. This is often confused with frequency as some plans that allow for recalls once every six months. Therefore, it may get confusing with only being able to go for a hygiene appointment once every six months. If for example your plan has twelve units and each of your hygiene appointments uses three units, you plan would cover a frequency of 4 three unit hygiene appointments per your calendar year but if your plan only allows for 6 units then your plan will only cover 2 three unit hygiene appointments per year. This is where things get tricky as what your hygienist may recommend may not align with what your insurance covers but this is something that can certainly be discussed once your treatment plan has been determined.

Fee Guide – Although most policies run on the most current fee guide based on the province of residence, some plans still run on a lag year or even more. This means, even if the claim was for this year, the paid amount by the insurance will be based on the fees from the year before or even two years before and so on. For example, if your plan covers at 100% at a 1-year lag, this means that you will have to pay for the difference in fees from the current year to the year before.

Choosing a dental plan that’s right for you can be fairly simple if you know what you need beforehand. And though optimal oral health is not based on dental coverage, it can certainly help plan out your journey to oral health in the best way possible for you. Here at Credit River Dental Centre, we can help answer and guide you through the dental insurance process so give us a call today at 905-278-4297 to book your appointment!