Many dental plans offer 3 classes or categories of coverage. If orthodontics is covered, that is considered a fourth class and typically has a separate lifetime maximum payable amount. Each class provides specific types of treatment and typically covers those treatments at a certain percentage. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully. If you are a Delta Dental of Virginia subscriber, you can access your plan’s details quickly and easily by logging into our secure subscriber website.
Here are the typical levels in benefit plans:
Class I (usually called Diagnostic & Preventive)
- Procedures are diagnostic and preventive and are typically covered at the highest percentage (for example, 90 – 100% of the allowable dental charge).
- Give patients a financial incentive to seek preventive care, because such care can prevent more extensive dental disease.
- Includes procedures such as dental exams, cleanings, and X-rays.
Class II (usually called Basic)
- Includes basic procedures — such as fillings, extractions, and periodontal treatment, such as “deep cleanings” and gum surgery — that are sometimes reimbursed at a slightly lower percentage (for example, 70 – 80%).
Class III (usually called Major)
- For major services, such as crowns and dentures. These services are usually reimbursed at a lower percentage (for example, 50%).
- May have a waiting period before services are covered.
Class IV (Orthodontics)
- These services are often reimbursed at 50% up to the lifetime maximum.
Limitations and Exclusions
- Dental plans are designed to help with a portion of your dental expenses. The typical plan includes limitations and exclusions, meaning the plan doesn’t cover every aspect of dental care. These limitations and exclusions may limit the type or number of procedures covered, or the number of visits, or may impose age limits.
If you want to find out more about your coverage specifics, log onto our website at DeltaDentalVa.com.
No matter what type of a dental benefit plan you have, it’s important to understand your plan offerings so that you can use your benefits to help improve your health.