Dental Benefit Categories and Coverages

by Jason 8/26/2014 9:45 AM

Many dental plans offer three classes or categories of coverage. Each class provides specific types of treatment and typically covers those treatments at a certain percentage.

Each class also specifies limitations and exclusions. Reimbursement levels vary from plan to plan, so be sure to read your benefits information carefully.

Here are the typical levels in benefit plans:

Class I (usually called Diagnostic and Preventative)

  • Procedures are diagnostic and preventive and typically are covered at the highest percentage (for example, 80 to 100 percent of the allowable dental charge).
  • Give patients a financial incentive to seek preventive care, because such care can prevent more extensive dental disease.

Class II (usually called Basic)

  • Includes basic procedures, such as fillings, extractions and periodontal treatment, which are sometimes reimbursed at a slightly lower percentage (for example, 60 to 80 percent).
  • Depending on your plan, class II services may have a waiting period before they are covered.

Class III  (usually called Major)

  • Major services, such as crowns and dentures, are usually reimbursed at a lower percentage (for example, 50 percent).
  • Depending on your plan, class III services may have a waiting period before they are covered.

Limitations and Exclusions

Dental plans are designed to help with part of your dental expenses. The typical plan includes limitations and exclusions, meaning the plan doesn’t cover every aspect of dental care. This can relate to the type or number of procedures, the number of visits or age limits.

If you want to find out more about your coverage specifics, log on to our websites at DeltaDentalMO.com or DeltaDentalSC.com. There you will find your specific benefits and usage. Or, call us to talk with a customer relation representative at (314) 656-3001.

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.

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