If dental benefit terms confuse you, you’re in good company. A 2013 survey found that 51% of U.S. adults were unable to accurately identify common health insurance terms. In order to better understand dental benefits, it’s important to start with the basics. That’s why we’re breaking down 4 commonly confused dental definitions – plain and simple.
Typically a monthly charge, a premium is the amount paid for your dental insurance policy to the dental insurance carrier, such as Delta Dental, for your coverage. If your coverage is provided through your employer, they may pay the premium in whole or in part.
A deductible is a specific dollar amount you pay before your insurance starts covering a portion of the costs. Deductibles usually apply to basic or major treatment, not cleanings and exams.
Once you reach your deductible, your insurance kicks in and will pay a percentage of the costs, while you pay the remaining percentage: this is your coinsurance. For example, if you have a filling and the percentage covered by your insurance carrier is 80%, your coinsurance, or the percentage of the procedure cost you would pay, is 20%.
A co-pay is NOT the same as coinsurance. It is a flat fee that you pay each time you use your benefits and is due at the time of your visit. An example would be $15 for a routine dental check-up.
Premium, deductible, coinsurance and co-pay amounts vary based on plan design. If you are a Delta Dental of Virginia subscriber, you can log into our secure subscriber website for detailed benefits information.
What other questions do you have about dental benefits? Are there additional terms you’re confused about? Let us know in the comments section!