Many dental plans offer three categories of coverage. Each category provides specific types of treatment and typically covers those treatments at a certain percentage.
Each category also specifies limitations and exclusions. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully.
Here are the typical levels in benefit plans:
Diagnostic & Preventive
Procedures are diagnostic and preventive and typically are covered at the highest percentage (for example 90 – 100% of the allowable dental charge).
Give patients a financial incentive to seek preventive care, because such care can prevent more extensive dental disease or even dental disease itself.
Includes basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example 70 – 80%).
For major services, such as crowns and dentures. This is usually reimbursed at a lower percentage (for example, 50%).
Major services may have a waiting period before services are covered.
Limitations and Exclusions
Dental plans are designed to help with part of your dental expenses. The typical plan includes limitations and exclusions, meaning the plan doesn’t cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits.
To find out more about your plan benefits, go to our website at www.HawaiiDentalService.com and log on as a member. Or, call us to talk with a customer relations representative at 529-9248 or toll-free at (800) 232-2533 ext. 248.
No matter what type of a dental benefit plan you have, it’s important to understand your plan offerings so that you can use your benefits to help improve your health.