|
 |
|
Glossary of Dental Terms
The following explanations will help you understand how the dental
plans work:
-
Annual Benefit Maximum
For each calendar year (January 1 through December 31), each
plan pays a maximum dollar amount toward your covered dental expenses.
Once your dental benefits reach this dollar maximum, you are not
eligible for dental benefits until the beginning of the next calendar
year.
-
Copayment
After the plan pays a percentage of the usual and customary
fee for dental services, the remaining cost is your copayment.
For example, if the plan pays 80% of a service, the remaining 20%
is your copayment. Keep in mind, the actual charges may be greater
than what the insurance company defines as a usual and customary
charge. If so, you are responsible for payment of any amounts over
the usual and customary limits.
-
Dentist
For the purposes of these plans, a dentist must be licensed
and acting within the scope of his/her profession. Any other doctor
or professional providing dental services must also operate within
the scope of services he/she is licensed to perform.
-
Usual and Customary
The plans only pay benefits for charges that are within usual
and customary limits. This is an amount generally charged for similar
services within your geographic area. If the fee is higher than
the usual and customary charge, you are responsible for the remaining
percentage of the charge (your copayment), as well as the charges
above the usual and customary limit.
|
|
|
