6 Important Dental Insurance Terms You Should Know

Regular dental care is crucial to maintaining healthy teeth. Dental insurance helps you cover the costs of your care, from routine cleanings to major work. However, dental insurance plans contain several features and terms to know. Understanding these can help you feel more confident in the process of getting a policy and answer questions like “what does an annual maximum mean for dental insurance?” With that in mind, this article explains six important dental insurance terms to know.

1-Premium

Your premium is the price you pay to maintain coverage. Providers typically bill monthly or annually, and some may offer a small discount for annual payments. Dental insurance premiums tend to cost less than traditional health insurance, since it’s a form of supplemental insurance. However, your premiums depend on several factors: 

• Coverage amounts: Higher coverage amounts will require higher premiums. 

• Deductibles: Deductibles correlate inversely with premiums. Lower deductibles require higher premiums and vice-versa. 

• Provider network: Policies with wider provider networks may cost more. 

• Policy type: Different policy types may charge varying premiums to account for differences in flexibility and other benefits. 

• Insurance provider: Insurers vary in how they calculate premiums and may be in different financial situations. Therefore, each insurer may charge different amounts for the same coverage. 

 2-Deductible

The deductible is the amount your policy requires you to pay out of pocket before the insurer begins covering the costs. For example, imagine you have a $200 deductible for a treatment that costs $300. That means you must pay $200 out of pocket before your insurance helps with the remaining $100. As mentioned, premiums and deductibles are inversely correlated. Raising one lowers the other and vice-versa. 

Furthermore, some services — usually preventive care, like routine cleanings — are not subject to deductibles. Coverage kicks in immediately. This means people who only need routine care may opt for a higher deductible to save on premiums. Meanwhile, someone needing frequent care and more complex procedures may prefer higher premiums for a lower deductible.

3-Copayment and coinsurance

Copayments and coinsurance are two ways you may share the cost of coverage with your insurer. A copayment is a fixed cost you pay for a service. For example, your dental insurance may require $10 for a routine appointment that includes an oral exam and cleaning. Coinsurance is a percentage of a service’s total cost you must pay. For example, your insurer may require you to pay 20% of the cost of a basic service. The insurer then covers the rest. If your services require a deductible, you must meet that deductible first before coinsurance kicks in.

4-Provider network

Insurance companies negotiate contracts with dental providers to perform services for the company’s policyholders. In exchange, the insurer provides coverage and reimbursement to policyholders who visit these dental providers. This supplies the dental provider with a steady stream of patients while giving the patients access to inexpensive care. 

This list of dental providers is called the provider network. Visiting providers in-network, or within the provider’s network, qualifies you for the maximum coverage amount under your plan. Dental Paid Provider Organizations (DPPOs) may offer some reimbursement for out-of-network providers, but you’ll get the most coverage in-network. Meanwhile, Dental Health Maintenance Organizations (DHMOs) seldom offer reimbursement for visits to out-of-network providers. Either way, insurers differ in their provider networks even under the same kinds of dental plans. 

 5-Waiting period

A waiting period is a specified timeframe where coverage is not active. Insurers use these to prevent people from purchasing plans right after discovering they have a dental problem since insurance is meant to be a layer of security.  

Many dental plans don’t have waiting periods for preventive care. Meanwhile, basic and major procedures may have waiting periods whose lengths vary by insurer and coverage levels. Waiting periods tend to be shorter or nonexistent with higher-priced plans. If you need a procedure during that procedure’s waiting period, such as emergency care, you’ll likely have to pay the full cost out of pocket.

6-Annual maximum

An annual maximum for dental insurance is the highest dollar amount that an insurance plan will pay for covered dental services in a given year. Once you reach this limit, you’re responsible for paying any additional costs for dental care out of pocket. The annual maximum will reset at the beginning of each new policy year. These limits can vary depending on your specific insurance plan and provider. 

The bottom line 

Dental insurance can significantly improve your dental health by encouraging you to visit the dentist. However, understanding the terminology is key to getting the right policy. Premiums, deductibles, copayments and coinsurance, provider networks, waiting periods, and annual maximums are some of the most important features to know. Now that you know these terms, you can shop more confidently for a dental plan that fits your needs and budget.  

Content within this article is provided for general informational purposes and is not provided as tax, legal, health, or financial advice for any person or for any specific situation. Employers, employees, and other individuals should contact their own advisers about their situations. For complete details, including availability and costs of Aflac insurance, please contact your local Aflac agent.   

Aflac Coverage – Series A82000 – In Arkansas, Policies A82100RAR–A82400RAR. In Delaware, Policies A82100R–A82400R. In Idaho, Policies A82100RID–A82400RID. In New York, Policies NY82100–NY82400. In Oklahoma, Policies A82100ROK–A82400ROK. In Oregon, Policies A82100ROR–A82400ROR. In Pennsylvania, Policies A82100RPAR–A82400RPAR. In Texas, Policies A82100RTX–A82400RTX. In Virginia, Policies A82100RVA–A82400RVA. Not available in AK, MA, NM, NV, PR, RI and UT. 

Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York. 

Tier One Coverage – Series T80000 – In Arkansas, Policy T80000AR. In Delaware, Policy T80000. In Idaho, Policy T80000ID. In Oklahoma, Policy T80000OK. In Oregon, Policy T80000OR. In Pennsylvania, Policy T80000PA-DEN ONLY; T8000PA-DVH. In Texas, Policy T80000TX & T8000TXR. Not available in NJ, NY, or VA. Dental claims are administered by SKYGEN USA, LLC. Vision claims are administered by EyeMed Vision Care, LLC.  Hearing claims are administered by Nations Hearing.  

NOTICE: The coverage offered is not a qualified health plan (QHP) under the Patient Protection and Affordable Care Act (ACA) and is not required to satisfy essential health benefits mandates of the ACA. The coverage provides limited benefits. 

Coverage is underwritten by Tier One Insurance Company. Tier One Insurance Company is part of the Aflac family of insurers. In California, Tier One Insurance Company does business as Tier One Life Insurance Company (Tier One NAIC 92908). 

This is a brief product overview only. Coverage may not be available in all states. Benefits/premium rates may vary based on plan selected. Optional riders may be available at an additional cost. Plans and riders may also contain a waiting period. Refer to the exact plans and riders for benefit details, definitions, limitations and exclusions. For availability and costs, please contact your local Aflac agent/producer. 

Aflac WWHQ | Tier One Insurance Company | 1932 Wynnton Road | Columbus, GA 31999 

Z2500172                                                                   EXP3/26 

Contact Information:
Senior PR & Corporate Communications
Contact: Angie Blackmar, 706-392-2097 or [email protected]