Understanding your dental plan's schedule of benefits
When you enroll in a dental plan, you’ll receive access to the schedule of benefits for your specific plan. This important document provides a summary of the benefits you are eligible for under your plan as well as other information, including:
Coverage levels by category: The dental services covered by your plan fall into specific categories such as preventive, basic and major. Each category is covered at a certain percentage, and percentages may differ in and out of network. The schedule of benefits for your plan should list each category and the amount covered in and out of network.
Deductible: The deductible is the amount of dental expense you are responsible for before your plan's benefits are calculated. If your dental plan has a deductible, the individual and family amounts should be listed on the schedule of benefits.
Contract maximum: Your plan's contract maximum is the amount of dental expenses allotted to each member within the contract period. This amount should be specified on the schedule of benefits. It is important to note that for dental plans, the contract maximum is the most your plan will pay. If your plan has orthodontia benefits, a separate maximum will be specified for orthodontic services.
Copay: The copay is a set dollar amount you are required to pay for a specific service (typically an oral evaluation). If your dental plan has a copay, each person covered by your plan will be required to pay the dentist office the amount listed on your schedule of benefits per occurrence of the service.
Covered services: The schedule of benefits provides a list of all services covered in each category and includes any frequency limitations.
Exclusions: The exclusions section of the schedule of benefits lists services and procedures not covered by your plan.
Depending on your dental plan, you may receive your schedule of benefits online or through the mail. No matter how you access it, take a few minutes to review this important document and save it for future reference. Understanding this information can help you make the most of your dental plan and avoid surprise costs from your dentist.