What Do People Misunderstand about Dental Benefits?

Posted on July 8, 2019 in Dental benefit information

Do you understand what a waiting period or an effective date means for your dental plan? Did you know you can avoid costly surprises by requesting a pre-treatment estimate? Taking the time to understand more about your dental plan can be beneficial. Here's what you need to know.

What is an effective date?

The effective date refers to the day a member (an individual covered under a benefit plan) is eligible to start using the dental plan.1 For many employer-sponsored dental plans, the effective date is the first day of the month after the member starts their job. However, effective dates can vary by dental benefits carrier and plan type.

Dental coverage emphasizes preventive care. As a result, once members reach their effective dates, they can usually begin using their benefits to cover preventive services like exams and cleanings.

What is a waiting period?

After members reach their effective date, they still may not be eligible to receive benefits for all dental treatments — especially major services like crowns or dentures.2 Although it’s more common with individual plans,3 some employer-sponsored plans have a benefit waiting period. This is the amount of time before members are eligible to use their full coverage.

For example, if your plan has a six-month waiting period for basic non-preventive services, such as a routine tooth extraction or a filling, it wouldn’t cover those services during that time. Some plans will waive the waiting period if the member had dental coverage in the past 30 to 60 days.

As with effective dates, waiting periods can differ from plan to plan. If your plan does have them, make sure you are aware of any benefit waiting periods.

What if a procedure isn’t covered?4

If a member needs major dental work, they should check their coverage. In addition to waiting periods, some dental plans may not cover select procedures such as teeth whitening or orthodontia. Some plans also may not fully cover the cost of a certain procedure, but may offer an allowance towards the procedure. For example, a plan may not cover all costs for a tooth-colored filling, but pay up to the amount of a silver-colored filling. To ensure members are not surprised by their bill, they should ask their dentist for a pre-treatment estimate from their dental carrier. They should also check with their dental carrier to see what is covered before undergoing any major dental work. Even if the procedure is not covered due to a waiting period, it may be more costly to delay treatment if the problem worsens.

For more tips on understanding your Delta Dental of Illinois dental plan, visit our Dental Basics web page.

1 https://www.deltadental.com/us/en/protect-my-smile/dental-benefits/library-of-terms.html

2 https://www.deltadental.com/us/en/protect-my-smile/dental-benefits/library-of-terms.html

3 https://www.investopedia.com/articles/personal-finance/122315/6-dental-insurance-plans-no-waiting-periods.asp

4 https://www.thebalance.com/dental-insurance-waiting-period-2645722