Frequently Asked Questions (FAQ) | Dental

Most dental insurance plans cover preventive services (like cleanings and exams), basic services (such as fillings and extractions), and major services (like crowns and bridges).

Some dental insurance plans offer coverage for orthodontic treatments, but it often requires an additional premium or comes with higher out-of-pocket costs. 

Most dental insurance plans do not cover cosmetic procedures, such as teeth whitening or veneers, unless they are necessary for medical reasons.

A waiting period is the time you must wait after enrolling in a dental insurance plan before certain services are covered.

You can review your plan’s benefits summary, contact your insurance provider, or ask your dentist to verify coverage for specific procedures.

Preventive services include routine dental exams, cleanings, X-rays, and fluoride treatments aimed at preventing dental issues.

Coverage for dental implants varies by plan. Some plans may cover part of the cost, while others might not cover implants at all.

Many dental insurance plans cover periodontal treatments, such as scaling and root planing, though coverage levels can vary.

Oral surgeries, such as tooth extractions and treatment for oral diseases, are typically covered by dental insurance, but coverage details depend on the plan.

What are major services in dental insurance? Major services include more extensive and costly procedures such as crowns, bridges, dentures, and oral surgery.

Most dental insurance plans do not exclude coverage for pre-existing conditions but may impose waiting periods before coverage begins.

Coverage for night guards and other dental appliances depends on the plan; some may cover them if deemed medically necessary.

Yes, many dental insurance plans cover root canals as they are considered a basic or major service.

Sealants are often covered for children as a preventive measure against cavities, but coverage for adults may vary.

Emergency dental services are typically covered, but the level of coverage and specific procedures included can vary by plan.

Yes, dentures are usually covered under major services, but the amount covered may vary depending on the plan.

Most dental insurance plans have an annual maximum limit on the amount they will pay for covered services each year.

Dental X-rays are generally covered under preventive services, although the frequency of coverage may vary by plan.

Eligibility varies by plan, but generally, individuals, families, and groups (through employers) can obtain dental insurance.

You can usually enroll during open enrollment periods, special enrollment periods (due to life events), or anytime if you are purchasing an individual plan.

Open enrollment is a designated period when you can sign up for or make changes to your dental insurance plan.

Most dental insurance plans do not exclude coverage for pre-existing conditions, but waiting periods may apply.

Yes, most dental insurance plans allow you to add family members, including spouses and children, to your policy.

Can I get dental insurance if I am self-employed? Yes, self-employed individuals can purchase individual dental insurance plans directly from insurance providers or through the health insurance marketplace.

A special enrollment period is a time outside the open enrollment period when you can sign up for or change your dental insurance due to qualifying life events.

Yes, but only if you qualify for a special enrollment period due to a qualifying life event, such as marriage or loss of other coverage.

You may need identification, proof of address, and details about any other insurance you have, depending on the provider's requirements.

Dependent coverage includes only children or dependents, while family coverage includes the policyholder, spouse, and dependents.

Employer-sponsored plans often offer lower premiums, broader coverage, and the convenience of payroll deductions.

If your new employer offers dental insurance, you can enroll in their plan. You may also continue your previous coverage through COBRA temporarily.

You qualify for COBRA dental insurance if you lose your job or experience a reduction in work hours, allowing you to continue your employer-sponsored coverage temporarily.

Yes, retirees can obtain dental insurance through retiree plans offered by former employers, individual plans, or Medicare Advantage plans that include dental coverage.

Yes, some dental insurance plans are designed for seniors, offering coverage for common senior dental needs like dentures and periodontal care. 

Can I get dental insurance for my child only? Yes, many providers offer dental insurance plans specifically for children, often covering preventive care, sealants, and orthodontics.

Most dental offices will file claims on your behalf. If you need to file a claim yourself, complete the claim form provided by your insurer and submit it along with the itemized bill from your dentist.

Claim processing times vary by provider but typically take between a few days to several weeks.

Review the denial notice, contact your insurance provider for clarification, and consider filing an appeal if you believe the denial was in error. 

Follow the appeal process outlined in your insurance policy, which may include submitting a written appeal with supporting documentation from your dentist. 

Provide the itemized bill from your dentist, your insurance policy details, and any additional information requested by your insurer.

Yes, you can check the status of your claim by logging into your insurance provider’s online portal or calling their customer service.

An EOB is a statement from your insurance provider that explains what services were covered, how much was paid, and any remaining amount you owe. 

The EOB includes details about the services provided, the amount billed, the allowed amount, what the insurance paid, and your responsibility.

Common reasons include incomplete or incorrect information, lack of coverage for the procedure, or exceeding benefit limits.

If your plan allows, you can submit a claim for reimbursement for covered services paid out-of-pocket. Provide the necessary documentation and follow your insurer’s process.

How do I know if my dental insurance is a good value? Compare the cost of premiums, deductibles, coverage limits, and the range of services covered to determine if the plan meets your needs and budget.

Typically, HSAs and FSAs can be used to pay for out-of-pocket dental expenses, but not for insurance premiums.

Coordinate benefits between the plans to maximize coverage and minimize out-of-pocket costs. The primary plan pays first, and the secondary plan may cover remaining expenses.

A dental insurance broker helps you find and compare dental insurance plans, providing expert advice and assistance with enrollment.

Traditional Medicare does not cover routine dental care, but some Medicare Advantage plans offer dental benefits.

Yes, dental insurance is available through the Health Insurance Marketplace, either as a stand-alone plan or as part of a health insurance plan.

Review any changes in coverage, premiums, network providers, and your dental needs to ensure the plan continues to meet your requirements.

Follow your insurer’s dispute resolution process, which may include filing a formal complaint, appealing decisions, or seeking external arbitration 

Preventive care helps detect and treat dental issues early, reducing the need for more extensive and costly treatments, and is often fully covered by insurance.

Contact your insurance provider to update personal information, such as address, contact details, or changes in coverage needs.

Some insurance providers offer plans that cover dental emergencies while traveling abroad, but routine care may not be included. 

Carefully read the policy documents, ask your insurance provider for clarification, and consider consulting a dental insurance broker for guidance.

Some plans offer incentives for regular preventive care visits, such as lower premiums, reduced co-pays, or bonus benefits.

State insurance departments regulate insurance providers, ensuring compliance with state laws and protecting consumers' rights.

Yes, some employers include dental insurance as part of a comprehensive wellness program, encouraging overall health and well-being.

• Visit our website for detailed information on dental insurance carriers, plan options, and frequently asked questions.
• You can also access additional information by calling directly using a Toll Free phone number at (877) 977-7026. A license agent is available to assist you.