Many dental plans offer 3 classes or categories of coverage. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.
Each class 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:
Class I (usually called Diagnostic & Preventative)
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.
Typically not subject to deductible.
Class II (usually called Basic)
Includes basic procedures — such as fillings, extractions, oral surgery, and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example 70 – 80%).
Typically subject to deductible and plan year maximum.
Class III (usually called Major)
For major services, such as crowns and dentures. This is usually reimbursed at a lower percentage (for example, 50%).
Class III may have a waiting period before services are covered.
Typically subject to deductible and plan year maximum.
Other Benefits:
Orthodontic benefits – a typical lifetime benefit for comprehensive orthodontic treatment is 50% up to a lifetime benefit of $1,500. It is not usually subject to a deductible and is separate from the plan year maximum.
Implant coverage – when covered, it is typically included as a Class III benefit and subject to deductible and coinsurance.
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.
If you want to find out more about your coverage specifics, log on to our website at DeltaDentalNJ.com. There you will find your specific benefits and usage. Or, call us to talk with a customer relation representative at 800-452-9310.
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.