Room · Dental & fixed benefit
Dental and fixed-benefit plans, in plain words.
Flat-rate plans pay a set amount. Dental plans have yearly maximums and waiting periods. We find which applies to you.
Situations that come up a lot
Crown or filling
What is covered, and whether the plan counts it as "basic" or "major" work.
Implants
Often treated differently from crowns. The plan's list of covered services says.
Braces
Usually have their own rules, age limits and lifetime amounts.
You paid first
You paid the dentist and now you want to be paid back. The form and receipts matter most.
Questions people ask here
Does my dental plan cover implants?
We look in the filed forms for implants, by name and by code, and show the page. If we can't find it, we say "Don't know yet."
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How long is the waiting period for major work?
Many plans make you wait before major work like crowns or implants. Your plan lists the waiting period by service name. We look for it in the filed forms and show the page.
What is the yearly maximum?
The most a dental plan pays in one plan year. After that you pay. It is usually printed near the benefits table.
Does a pre-treatment estimate matter?
For bigger work, many plans let your dentist send the plan for review first. Ask your insurer whether yours does.
Can I use any dentist?
Many plans pay more for dentists in their network. Check your plan's network list before you book.
What is a fixed-benefit plan?
A plan that pays a set amount for a service or a day, whatever the bill says. Your plan lists the amounts.
Papers to gather
- Itemized dentist bill
- Treatment dates and procedure codes
- Proof of payment
- Claim form
- Member ID card
- X-rays, only if asked
A deadline, as an example
Your dates are in your own policy and letters.
Example
Day 0
Treatment date.
Day 90
Typical window on many forms. Yours may differ.
Day 365
Some plans allow a year. Check the page.