Dental

Glossary of Dental Terms

Your coverage generally ends on the earliest of the:

• 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.