Understanding Your Dental Plan: Benefit Categories and Coverages

Many dental plans offer three classes or categories of covered services, often with different reimbursement levels for each.

Confused about the details of your dental plan? We can help you make sense of it!

Comparing coverage between dental insurance plans? Trying to make sense of the dental benefits summary your employer gave you during open enrollment? We can help!

In addition to the annual maximum and deductible, you’ll want to review the covered services.  Many dental plans offer three classes or categories of covered services, often with different reimbursement levels for each. Each class provides specific types of treatment and typically covers those treatments at a certain percentage. Each class also specifies limitations and exclusions.

Class I – Diagnostic & Preventive

  • Procedures are diagnostic and preventive. Examples may include exams, X-rays and routine cleanings.
  • Diagnostic and preventive procedures are typically covered at the highest percentage (for example, 90-100% of the allowable charge).
  • Patients have a financial incentive to seek preventive care because such care can deter dental disease and the need for more expensive treatments in the future.

Class II – Basic

  • Basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example, 70–80%).
  • Deductibles may apply to these services.

Class III – Major

  • For major services, such as crowns and dentures. This is usually reimbursed at a lower percentage (for example, 50%).
  • There may be a waiting period before major services are covered.
  • Deductibles may apply to these services.

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.

Each plan’s provisions are different, so it’s important to review your benefits information carefully to understand how your plan works and what types of cost-sharing elements you can expect. With a better understanding of the benefits included in your dental plan, you can have a key role in your oral health and wellness—and develop realistic expectations of how your dental insurance can work for you.

Have questions about the coverage available through your Delta Dental of Arizona plan? Log in to the Member Connection to find your specific plan details and benefits usage or call us to talk with a customer service representative at 602-938-3131, option 1.

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