Whether you are looking for a new plan or trying to determine your coverage options for your current plan, understanding your dental insurance policy can be a real headache. Insurance companies have a tendency to use confusing terms and jargon, and if you do not understand them, you might not be getting the most out of your coverage. Here are some of the most important that you will want to know.
This is the amount of money that your insurance has agreed to pay for a service or supply. This might be different from the amount that your health care professional has billed, but your insurance company has likely negotiated a special rate for members.
The annual limit is the total max dollar amount that your insurance company will play for insurance claims within a given year. This might also be referred to as a calendar year maximum, but some plans might not have a set annual limit.
A claim is a formal request that is made by the healthcare provider or a covered party to an insurance company when requesting payment for a service or procedure.
Coinsurance is the amount that a covered party needs to pay for a service after deductibles and copayments are met. This is your portion of the cost for services.
A copayment is a charge that has been pre-set by the insurance plan, and it is the amount that you will need to pay for prescriptions, medical supplies, or services. For example, your insurance company might charge a copayment of $25 for your dental visit.
The deductible is the amount of money that your insurance company will require that you pay each year before your insurance will start to kick in. Typical deductible amounts are $1,000, $2,500, or $5,000, but not all plans will have a deductible.