Avoid Surprises With Dental Benefits – Part 1


Choosing a dental plan can be confusing. Plans may look similar, but in reality each one is designed differently. This blog features five of 10 tips for evaluating dental plan and coverage options to help you avoid surprises with your benefits. Be sure to read Part 2 for the remaining five tips.


  1. Covered procedures – Review covered procedures and reimbursement categories. Most carriers list procedures in different categories, such as X-rays, root canals (endodontics), gum disease treatment (periodontics) or oral surgery. If you are working with a participating provider network (PPO), know whether these procedures are classified as preventive, basic or major, as this will impact rates and out-of-pocket costs for employees and their family members. If special services are important, such as dental implants, cosmetic fillings, teeth whitening or orthodontia for adults, make sure they are included in the plan.
  2. Deductibles and annual maximums If the plan has a deductible, know the amount, when it applies and the annual benefit maximum available per year. If orthodontia is included, find out the lifetime benefit available.
  3. Coinsurance and copayment amounts – For PPO plans, know the percent paid by procedure category, typically stated as preventive, basic or major. For dental maintenance organization (DMO) plans, it is important to know the members’ costs for common procedures.
  4. Frequency limitations – Ask how often each type of X-ray can be taken, and how many cleanings are permitted, each year. It is also important to know whether there are limitations on the number of years allowed between crown replacements. For example, one carrier may approve replacement of crowns every five years, while another may extend the limit to 10 years.
  5. Waiting periods and participation requirements – Some plans have procedures that require a waiting period, or coverage policies that differ between current employees and new hires. It is also important to know whether the carrier requires a specific percentage of eligible employees to participate in the plan before coverage is available.

To learn more, download our latest white paper: 10 tips for reviewing dental plans.