Dental Terms Made Easy

From Business Health Trust dental provider Delta Dental of Washington

Open enrollment may be coming soon, which may include lots of insurance jargon. Here are a few of the top terms that may help guide your decisions.

Annual Maximum: This is the total amount your dental plan will cover within a one-year period. Typically, a calendar year.

Coinsurance: This is the amount you are responsible for if your plan does not cover the entire (100%) procedure. For example, your plan may cover a filling at 50% of the cost. You would be responsible for the 50% balance.

Copay: A copay fee is the fixed amount you would pay for a procedure and not a percentage regardless of the actual cost. For example, your plan may stipulate the copay for a filling is $100. The actual cost may be $300 but your cost will remain $100.

Deductible: This is the amount you will pay before your insurance plan will start covering your care.

Explanation of Benefits (EOB): You will receive an EOB after your procedures. This is not a bill but an explanation of all the services and the amount the insurance plan will cover.

Network: This is the group of dental providers approved to serve you with dental procedures. They have been credentialed and trained for enrolled members.

Open enrollment: This is a once-a-year period employers offer eligible employees to sign up for medical or dental services. This is your opportunity to add or remove coverage.

More dental insurance terms can be viewed in the Delta Dental of Washington glossary.