What is a “Benefit Waiting Period”?

Posted on October 24, 2019 in Dental benefit information

After enrolling in a new dental plan, coverage for some services could be subject to a benefit waiting period. A benefit waiting period is the amount of time before you are eligible to receive benefits for all or certain dental treatments.

Every dental plan is different, but typically, there are no waiting periods for diagnostic and preventive services such as cleanings and exams. So after your plan's effective date, your benefits will normally cover preventive dental care.

On the other hand, your dental plan may have a 6- or 12-month waiting period for certain services. For example, some plans may require a 6-month waiting period for basic restorative services, such as fillings and non-surgical extractions; or a 12-month waiting period for major services, such as crowns or dentures. Most individual and family dental benefit plans (purchased independently not through an employer) have waiting periods.

Say for instance your new dental plan has a 12-month waiting period for major services and your dentist informs you that you need a crown. If your coverage is effective on July 1, your plan will not cover a portion of the cost for a major service, such as a crown, until July 1 of the following year.

Depending on your dental plan, benefit waiting periods may be waived if you or your dependents were covered for 12 continuous months under another dental benefits plan. However, most dental plans will require that your previous coverage ended recently (usually within the past 30 to 60 days) to qualify for waiting periods to be waived. You may need to provide proof of prior coverage to your dental benefits carrier.

Generally, waiting periods must be satisfied if there has been a lapse in coverage or for new members added to a policy. Review your Delta Dental of Illinois dental plan's coverage details for waiting period specifics by logging into your account at www.deltadentalil.me. If you are looking to enroll in a Delta Dental of Illinois plan, please visit deltadentalil.me for plan options. For enrollment help or questions, please contact us at 877-824-2776, 8:30 a.m. to 5:00 p.m. central time, Monday through Friday or by email at individual@deltadentalil.com.