Full Coverage Plans
Only suggested for those with no dental issues now or foreseen in the future. Covered care:
For the average client. Care provided:
This includes full along with optional coverage of your choice:
Care that is implemented to prevent extensive issues from happening.
Care that requires immediate attention to prevent major issues from happening
Complex procedures to normalize gums and teeth
A co-pay may disregard the deductible, co-insurance and out of pocket maximum. The co-pay is subject to specific services on your plan. For example, if your co-pay is $5 per generic brand prescription, each time you go to the pharmacy to obtain this or get a refill you will need to pay $5.
After a deductible is meet, co-insurance for each medical bill is implemented.
Co-Insurance for doctor visits are 80%, which means you pay 20% of the bill. If the bill was $1,000, then you would pay $200.
A dollar amount required for the insured to pay before the insurance company will pay your medical bills. This dollar amount may be per person/family on your plan.
Your family deductible is $900 and your individual deductible is $1,000. You went to the doctor for an annual checkup costing $200 and the following week your son went to the ER for an injury with a bill of $1,300, then the insurance company will pay $500 (1,000 – 200 – 1,300) of your son’s bill along with paying co-insurance for each bill afterward.
Out of Pocket Maximum
The maximum amount an insured would pay after a deductible was meet.
The deductible was $1,000, co-insurance is 80% and the out of pocket maximum is $1,500. You received an injury with a bill of $1,500, you would pay $1,100 (1,000 deductible + 20% co-insurance * 500 remaining bill after deductible was met). Your son was sick and admitted to the hospital a month later leaving a bill of $10,000, you would pay $1,400 ( 10,000 bill * 20% co-insurance – 100 from going over deductible previously). Any more medical bills after this will be covered completely covered.
The insurance company paid $400 ((1,500 bill – 1,000 deductible) * 80% co-insurance) for the first incident and $8,100 (10,000 bill * 80% co-insurance + 100 from the insured going over deductible previously) for the second.
The dollar amount that you pay consistently to the insurance carrier to own an insurance policy.
The maximum amount of dollars an insurance company will spend on your insurance plan in a year.
The period of time since the plan starts that must be surpassed before the insurance company will pay for certain levels of care. Preventative care is covered immediately but basic or major care may only be covered after serveral months
- Simple Extractions
- Surgical Extractions
- Dental Implants
*This is not an all inclusive list and may vary by plan, carrier, or state.