Glossary

The most money your dental insurance will pay for covered procedures in a year. Once you reach this limit, you pay for additional costs until the next year begins.

Basic care services address common dental issues, such as fillings, simple tooth extractions or minor oral surgery.

The 12-month period your plan uses to calculate coverage limits, deductibles, and maximums. It may follow the calendar year or begin on your plan’s start date.

The insurance company that provides and administers your dental coverage. The carrier processes claims, pays benefits, sets coverage rules, and determines what services are included in your plan.

The fixed dollar amount a dental insurance plan pays out for specific procedures.

The percentage of the cost of dental services that a patient is responsible for paying after meeting any deductible. It’s a form of cost-sharing between the patient and the dental insurance provider. (typically a percentage like 20%)

Dental services that your dental insurance agrees to pay for, either fully or partially. This means your dental insurance will help with the out-of-pocket costs.

The amount of money you must pay before your dental insurance starts to pay.

Treatments or conditions your plan does not cover. These are listed in your policy documents and might include things like cosmetic procedures or orthodontics.

Major care services involve more complex treatments like root canals, crowns, bridges or dentures.

A dentist that has an agreement with your dental insurance to provide services at reduced rates.

A provider that doesn’t belong to your policy’s covered network. Out-of-network providers could still accept your insurance, but they are not bound to agreed-upon pricing for services like in-network providers are.

A cost estimate from your insurance company for a dental procedure before you receive it. It shows what your plan will pay and what you may owe.

Focused on maintaining dental health, these are dental services you get to prevent bigger problems down the road. For example, cleanings, exams or X-rays.

The amount of time you must wait before you can receive coverage for certain treatments or services.