FAQ – Getting to Know Dental Benefits

November 6, 2019

Choosing a Dental Plan? Get to Know Our Dental Benefits First.

As you’re choosing a dental plan, we understand that you may have questions – OK, maybe lots (and rightfully so). Selecting a plan that works for you and your family is a big deal and insurance isn’t always crystal clear. But don’t fret, we are here to make it easy. Let us help you by covering some basics on how dental insurance works and what type of plan (co-pay vs co-insurance) fits best for your situation. First, let’s set the foundation and review some frequently asked questions on dental benefits.


Q: What is the difference between preventive, basic and major categories?

A: Procedures are typically grouped into three coverage categories: Preventive, basic and major. However, these can vary by plan so it’s good to check with your personal policy to see what’s covered. You’ll want to take a look at the plan summary anyway so you can see the perks that are included, things like discounts on cosmetic services and vision.

  • Preventive care consists of things like routine exams, cleanings and x-rays.
  • Basic procedures are for procedures like fillings, extractions, root canals.
  • Major procedures typically include crowns, bridges and dentures.


Q: What is a deductible?

A: A deductible is the portion of dental care expenses you will pay before the dental plan starts paying benefits. Usually this will apply to basic and major services, but you can double check on your plan summary. It’s also important to mention that groups with less than 6 employees will have a deductible for a copay plan and groups with 6 or more will have no deductible (note: this applies to Utah and Texas only).


Q: What is a maximum benefit?

A: This is the maximum dollar amount the plan will pay towards the costs incurred by an individual. Typically, this is per member per calendar year. You’ll want to check which service categories this maximum applies to, but it’s usually preventive, basic and major.


Q: What is MaxRewards?

MaxRewards is special feature designed to reward members who stay on a Dental Select plan. For no additional cost, your maximum benefit will increase each year until reaching a $2,000 maximum. So, the longer you stay on a plan, the more you can accumulate for your future dental needs. To find out if your plan is eligible for MaxRewards, ask your company’s benefit representative for more information. MaxRewards is for groups only and doesn’t apply to individual plans.


Q: How do waiting periods work?

A waiting period is the time that must pass before some of your benefits can begin.


Q: Why is it important to know what network I am on?

A: You’ll want to double check what network you are on because using a network dentist will grant you lower out of pocket costs, full preventive service coverage plus additional discounts on other services. You can still use an out of network dentist but try to stay in network to get the most bang for your buck. An easy way to verify your network is looking at your ID card. If you haven’t signed up yet, try browsing the networks to see where your favorite dentist pops up. Use the provider search, and as a reminder, you can choose or change your dentist at any time.


Q: When can I begin using my benefits?

A: You’ll want to check your employer’s effective date, which is the day you can begin using your benefits (after new hire or other applicable waiting periods).


Q: What is a Co-Pay Plan?

A: A co-pay dental plan means you will have a fixed amount or flat-flee to pay at your dental visit. With this plan, all fees for procedures are listed on a fee schedule. You can receive a copy of your copay schedule in the portal or by contacting your HR rep. Your contracted dentist has agreed to use your plan’s fee schedule, so there are no surprises on what you will pay for each service. A patient will only be responsible for the difference between the contracted amount and the insurance payment (when using an in-network dentist). This total contracted amount paid per service to the dentist is shared between the patient and the insurance company – that is why the patient portion is called a “co-pay”. Other perks include: no co-pay on preventive services (since it is covered at 100%), affordable premiums, no annual maximums and short waiting periods. Currently, this plan is available in Utah and Texas only.



There’s no annual maximum on your coverage, so you use the benefits you need, as often as you need.
Gold and Platinum networks are available upon enrollment.
With fixed affordable co-payments, you know what costs to anticipate at your visit.
Take advantage of full benefits sooner with shorter waiting periods. Basic services are available within 6 months, and major services are available within 12 months.
Discounts are available when choosing a contracted provider for orthodontics, veneers and teeth bleaching.



Q: How does a Co-Insurance Plan work?

A: A co-insurance dental plan takes a percentage of what your dentist charges, which you will be responsible to pay after meeting your deductible. Percentages can be found on your dental plan summary. You’ll notice that the percentages will vary by the type of service category, so it’s important to check out your plan summary to see how it will be covered. For example, let’s say your visit is a basic procedure and costs $100. You check and see that your plan pays 80% for basic services. Assuming you have already met your deductible, the plan would then pay 80% of $100, ($80) and you would be responsible for the remaining balance ($20).


Contracted dentists have made special agreements with Dental Select to only charge up to a specific dollar amount for services. The advantage of a co-insurance plan is you will already know insurance will take care of the negotiated fee (the co-insurance percentage). Although you can visit a non-contracted dentist, it’s best to choose a contracted dentist to receive the most savings. Otherwise, when out of network, balance billing (when the patient becomes responsible for the difference between dental charges and insurance coverage) may occur. Other features include: 100% coverage on preventive care, in and out of network benefits and the option of your group to include orthodontic benefits.



All preventive services are covered entirely, including exams and cleanings (2 per year).
All members will receive vision discounts through the EyeMed Discount Vision plan at no additional cost. The Vision Discount Plan includes instant included discounts on vision services from the nation’s top retailers.
Receive high quality benefits for a more affordable premium.
Additional discounts are available on orthodontics, teeth bleaching and cosmetic services.



Why Dental Insurance?

Regular dental visits can decrease tooth decay, provide cost savings, help prevent costly procedures, improve your overall health and ensure early detection of oral cancer.

As a reminder, research has shown a strong association between poor dental hygiene and serious health conditions. Gum disease is linked to heart attacks and disease, strokes, diabetes and pneumonia.  With a well-established oral care routine, you can protect yourself from health problems and diseases.

Now that you have some important information under your belt, let’s take your decision process even further by checking out our providers. Have a favorite provider already? Verify what plan they are on. Need to find a provider? Search for one close to you. Then, you can be sure you are making the right decision and maximizing your savings.